Rate Of Fluid Reabsorption Research Articles

Recurrent reflex syncope in idiopathic intracranial hypertension patient resolved after lumbar puncture: pathogenetic implications

BackgroundIdiopathic intracranial hypertension is a disease characterized by increased intracranial cerebrospinal fluid volume and pressure without evidence of other intracranial pathology. Dural sinuses are rigid structures representing a privileged low-pressure intracranial compartment. Rigidity of dural sinus ensures that the large physiologic fluctuations of cerebrospinal fluid pressure associated with postural changes or to Valsalva effect cannot be transmitted to the sinus. An abnormal dural sinus collapsibility, especially when associated with various anatomical sinus narrowing, has been proposed as a key factor in the pathogenesis of idiopathic intracranial hypertension. This pathogenetic model is based on an excessive collapsibility of the dural sinuses that leads to the triggering of a self-limiting venous collapse positive feedback-loop between the cerebrospinal fluid pressure, that compresses the sinus, and the increased dural sinus pressure upstream, that reduces the cerebrospinal fluid reabsorption rate, increasing cerebrospinal fluid volume and pressure at the expense of intracranial compliance and promoting further sinus compression. Intracranial compliance is the ability of the craniospinal space to accept small volumetric increases of one of its compartments without appreciable intracranial pressure rise. In idiopathic intracranial hypertension, a condition associated with a reduced rate of CSF reabsorption leading to its volumetric expansion, a pathologically reduced IC precedes and accompanies the rise of ICP. Syncope is defined as a transient loss of consciousness due to a transient cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. A transient global cerebral hypoperfusion represents the final mechanism of syncope determined by cardiac output and/or total peripheral resistance decrease. There are many causes determining low cardiac output including reflex bradycardia, arrhythmias, cardiac structural disease, inadequate venous return, and chronotropic and inotropic incompetence. Typically, syncopal transient loss of consciousness is mainly referred to an extracranial mechanism triggering a decrease in cardiac output and/or total peripheral resistance. Conversely, the association of syncope with a deranged control of intracranial compliance related to cerebral venous outflow disorders has been only anecdotally reported.Case PresentationWe report on a 57-year-old woman with daily recurrent orthostatic hypotension syncope and idiopathic intracranial hypertension-related headaches, which resolved after lumbar puncture with cerebrospinal fluid subtraction.ConclusionsA novel mechanism underlying the triggering of orthostatic syncope in the presence of intracranial hypertension-dependent reduced intracranial compliance is discussed.

Renal and Vascular Effects of Combined SGLT2 and Angiotensin-Converting Enzyme Inhibition.

Background:The cardiorenal effects of sodium-glucose cotransporter 2 inhibition (empagliflozin 25 mg QD) combined with angiotensin-converting enzyme inhibition (ramipril 10 mg QD) were assessed in this mechanistic study in patients with type 1 diabetes with potential renal hyperfiltration.Methods:Thirty patients (out of 31 randomized) completed this double-blind, placebo-controlled, crossover trial. Recruitment was stopped early because of an unexpectedly low proportion of patients with hyperfiltration. Measurements were obtained after each of the 6 treatment phases over 19 weeks: (1) baseline without treatment, (2) 4-week run-in with ramipril treatment alone, (3) 4-week combined empagliflozin-ramipril treatment, (4) a 4-week washout, (5) 4-week combined placebo-ramipril treatment, and (6) 1-week follow-up. The primary end point was glomerular filtration rate (GFR) after combination treatment with empagliflozin-ramipril compared with placebo-ramipril. GFR was corrected for ramipril treatment alone before randomization. At the end of study phase, the following outcomes were measured under clamped euglycemia (4 to 6 mmol/L): inulin (GFR) and para-aminohippurate (effective renal plasma flow) clearances, tubular sodium handling, ambulatory blood pressure, arterial stiffness, heart rate variability, noninvasive cardiac output monitoring, plasma and urine biochemistry, markers of the renin-angiotensin-aldosterone system, and oxidative stress.Results:Combination treatment with empagliflozin-ramipril resulted in an 8 mL/min/1.73 m2 lower GFR compared with placebo-ramipril treatment (P=0.0061) without significant changes to effective renal plasma flow. GFR decrease was accompanied by a 21.3 mL/min lower absolute proximal fluid reabsorption rate (P=0.0092), a 3.1 mmol/min lower absolute proximal sodium reabsorption rate (P=0.0056), and a 194 ng/mmol creatinine lower urinary 8-isoprostane level (P=0.0084) relative to placebo-ramipril combination treatment. Sodium-glucose cotransporter 2 inhibitor/angiotensin-converting enzyme inhibitor combination treatment resulted in additive blood pressure–lowering effects (clinic systolic blood pressure lower by 4 mm Hg [P=0.0112]; diastolic blood pressure lower by 3 mm Hg [P=0.0032]) in conjunction with a 94.5 dynes × sex/cm5 lower total peripheral resistance (P=0.0368). There were no significant changes observed to ambulatory blood pressure, arterial stiffness, heart rate variability, or cardiac output with the addition of empagliflozin.Conclusions:Adding sodium-glucose cotransporter 2 inhibitor treatment to angiotensin-converting enzyme inhibitor resulted in an expected GFR dip, suppression of oxidative stress markers, additive declines in blood pressure and total peripheral resistance. These changes are consistent with a protective physiologic profile characterized by the lowering of intraglomerular pressure and related cardiorenal risk when adding a sodium-glucose cotransporter 2 inhibitor to conservative therapy.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02632747.

20-OR: The Renal and Vascular Effects of Combined SGLT2 and Angiotensin Converting Enzyme Inhibition

The goal of this mechanistic trial was to determine the kidney and cardiovascular effects of combined treatment with an SGLT2i (empagliflozin 25mg QD) and an ACEi (ramipril 10mg QD) for 4 weeks in patients at risk of renal hyperfiltration. In this randomized, double-blind, placebo-controlled, cross-over trial, measurements were obtained following each of the 4 treatment phases: 1) no treatment, 2) 4-week ramipril treatment alone, 3) 4-week empagliflozin-ramipril combination treatment, and 4) 4-week placebo-ramipril combination treatment. The primary endpoint was GFR after empagliflozin-ramipril treatment compared to placebo-ramipril. At the end of each study phase the following measurements were performed under clamped euglycemia (4-6 mmol/L) : inulin (GFR) and paraaminohippurate (effective renal plasma flow, ERPF) clearances, tubular sodium handling, ambulatory blood pressure, arterial stiffness, heart rate variability, non-invasive cardiac output monitoring, plasma and urine biochemistry. Empagliflozin-ramipril treatment resulted in an 8ml/min/1.73m2 lower GFR (p=0.0061) , lower absolute proximal fluid reabsorption rate (p=0.0092) , lower absolute proximal sodium reabsorption rate (p=0.0056) , and lower urinary 8-isoprostane (p=0.0084) relative to placebo-ramipril treatment. Empagliflozin-ramipril treatment resulted in additive blood pressure lowering effects (SBP p=0.0112; DBP p=0.0032) and a lower total peripheral resistance (p=0.0368) . There were no other significant changes observed with the addition of empagliflozin. SGLT2i-ACEi combination treatment resulted in an expected GFR “dip”, suppression of oxidative stress markers, and additive declines in blood pressure and total peripheral resistance in this mechanistic study. These changes are consistent with a protective physiological profile characterized by the lowering of intraglomerular pressure and related cardiorenal risk when adding an SGLT2i to conservative therapy. Disclosure Y. Lytvyn: None. K. Kimura: Employee; 3Boehringer Ingelheim Canada Ltd./Ltée. N. Peter: Employee; Boehringer Ingelheim Pharma GmbH & Co.KG. V.S. Lai: Advisory Panel; Baxter. J. Tse: None. L. Cham: None. B.A. Perkins: Advisory Panel; Abbott Diabetes, Insulet Corporation, Sanofi. Board Member; Novo Nordisk. Research Support; BMO Bank of Montreal, Novo Nordisk. Other Relationship; Abbott Diabetes, Insulet Corporation, Medtronic, Novo Nordisk. N. Soleymanlou: Employee; Boehringer Ingelheim Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals Inc. D. Cherney: Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca and Novo-Nordisk. Other Relationship; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Research & Development, LLC, Lilly, Maze, BMS, CSL-Behring, Merck, Otsuka, Novartis and Novo-Nordisk, Mitsubishi Tanabe Pharma Corporation, Sanofi. Funding Boehringer Ingelheim and CIHR, Diabetes Canada and the Heart and Stroke Richard Lewar Centre of Excellence and the Heart and Stroke Foundation of Canada

Two-compartment model of inner medullary vasculature supports dual modes of vasopressin-regulated inner medullary blood flow

The outer zone of the renal inner medulla (IM) is spatially partitioned into two distinct interstitial compartments in the transverse dimension. In one compartment (the intercluster region), collecting ducts (CDs) are absent and vascular bundles are present. Ascending vasa recta (AVR) that lie within and ascend through the intercluster region (intercluster AVR are designated AVR(2)) participate with descending vasa recta (DVR) in classic countercurrent exchange. Direct evidence from former studies suggests that vasopressin binds to V1 receptors on smooth muscle-like pericytes that regulate vessel diameter and blood flow rate in DVR in this compartment. In a second transverse compartment (the intracluster region), DVR are absent and CDs and AVR are present. Many AVR of the intracluster compartment exhibit multiple branching, with formation of many short interconnecting segments (intracluster AVR are designated AVR(1)). AVR(1) are linked together and connect intercluster DVR to AVR(2) by way of sparse networks. Vasopressin V2 receptors regulate multiple fluid and solute transport pathways in CDs in the intracluster compartment. Reabsorbate from IMCDs, ascending thin limbs, and prebend segments passes into AVR(1) and is conveyed either upward toward DVR and AVR(2) of the intercluster region, or is retained within the intracluster region and is conveyed toward higher levels of the intracluster region. Thus variable rates of fluid reabsorption by CDs potentially lead to variable blood flow rates in either compartment. Net flow between the two transverse compartments would be dependent on the degree of structural and functional coupling between intracluster vessels and intercluster vessels. In the outermost IM, AVR(1) pass directly from the IM to the outer medulla, bypassing vascular bundles, the primary blood outflow route. Therefore, two defined vascular pathways exist for fluid outflow from the IM. Compartmental partitioning of V1 and V2 receptors may underlie vasopressin-regulated functional compartmentation of IM blood flow.

High CO2 Levels Impair Alveolar Epithelial Function Independently of pH

BackgroundIn patients with acute respiratory failure, gas exchange is impaired due to the accumulation of fluid in the lung airspaces. This life-threatening syndrome is treated with mechanical ventilation, which is adjusted to maintain gas exchange, but can be associated with the accumulation of carbon dioxide in the lung. Carbon dioxide (CO2) is a by-product of cellular energy utilization and its elimination is affected via alveolar epithelial cells. Signaling pathways sensitive to changes in CO2 levels were described in plants and neuronal mammalian cells. However, it has not been fully elucidated whether non-neuronal cells sense and respond to CO2. The Na,K-ATPase consumes ∼40% of the cellular metabolism to maintain cell homeostasis. Our study examines the effects of increased pCO2 on the epithelial Na,K-ATPase a major contributor to alveolar fluid reabsorption which is a marker of alveolar epithelial function.Principal FindingsWe found that short-term increases in pCO2 impaired alveolar fluid reabsorption in rats. Also, we provide evidence that non-excitable, alveolar epithelial cells sense and respond to high levels of CO2, independently of extracellular and intracellular pH, by inhibiting Na,K-ATPase function, via activation of PKCζ which phosphorylates the Na,K-ATPase, causing it to endocytose from the plasma membrane into intracellular pools.ConclusionsOur data suggest that alveolar epithelial cells, through which CO2 is eliminated in mammals, are highly sensitive to hypercapnia. Elevated CO2 levels impair alveolar epithelial function, independently of pH, which is relevant in patients with lung diseases and altered alveolar gas exchange.

Flash photolysis of caged nitric oxide inhibits proximal tubular fluid reabsorption in free-flow nephron

A nonobstructing optical method was developed to measure proximal tubular fluid reabsorption in rat nephron at 0.25 Hz. The effects of uncaging luminal nitric oxide (NO) on proximal tubular reabsorption were investigated with this method. Proximal fluid reabsorption rate was calculated as the difference of tubular flow measured simultaneously at two locations (0.8-1.8 mm apart) along a convoluted proximal tubule. Tubular flow was estimated on the basis of the propagating velocity of fluorescent dextran pulses in the lumen. Changes in local tubular flow induced by intratubular perfusion were detected simultaneously along the proximal tubule, indicating that local tubular flow can be monitored in multiple sites along a tubule. The estimated tubular reabsorption rate was 5.52 +/- 0.38 nl.min(-1).mm(-1) (n = 20). Flash photolysis of luminal caged NO (potassium nitrosylpentachlororuthenate) was induced with a 30-Hz UV nitrogen-pulsed laser. Release of NO from caged NO into the proximal tubule was confirmed by monitoring intracellular NO concentration using a cell-permeant NO-sensitive fluorescent dye (DAF-FM). Emission of DAF-FM was proportional to the number of laser pulses used for uncaging. Photolysis of luminal caged NO induced a dose-dependent inhibition of proximal tubular reabsorption without activating tubuloglomerular feedback, whereas uncaging of intracellular cGMP in the proximal tubule decreased tubular flow. Coupling of this novel method to measure reabsorption with photolysis of caged signaling molecules provides a new paradigm to study tubular reabsorption with ambient tubular flow.

Dopamine increases lung liquid clearance during mechanical ventilation.

Short-term mechanical ventilation with high tidal volume (HVT) causes mild to moderate lung injury and impairs active Na+ transport and lung liquid clearance in rats. Dopamine (DA) enhances active Na+ transport in normal rat lungs by increasing Na+-K+-ATPase activity in the alveolar epithelium. We examined whether DA would increase alveolar fluid reabsorption in rats ventilated with HVT for 40 min compared with those ventilated with low tidal volume (LVT) and with nonventilated rats. Similar to previous reports, HVT ventilation decreased alveolar fluid reabsorption by ~50% (P < 0.001). DA increased alveolar fluid reabsorption in nonventilated control rats (by ~60%), LVT ventilated rats (by approximately 55%), and HVT ventilated rats (by ~200%). In parallel studies, DA increased Na+-K+-ATPase activity in cultured rat alveolar epithelial type II cells (ATII). Depolymerization of cellular microtubules by colchicine inhibited the effect of DA on HVT ventilated rats as well as on Na+-K+-ATPase activity in ATII cells. Neither DA nor colchicine affected the short-term Na+-K+-ATPase alpha1- and beta1-subunit mRNA steady-state levels or total alpha1- and beta1-subunit protein abundance in ATII cells. Thus we reason that DA improved alveolar fluid reabsorption in rats ventilated with HVT by upregulating the Na+-K+-ATPase function in alveolar epithelial cells.

Alveolar fluid reabsorption is impaired by increased left atrial pressures in rats.

Cardiogenic pulmonary edema results from increased hydrostatic pressures across the pulmonary circulation. We studied active Na(+) transport and alveolar fluid reabsorption in isolated perfused rat lungs exposed to increasing levels of left atrial pressure (LAP; 0--20 cmH(2)O) for 60 min. Active Na(+) transport and fluid reabsorption did not change when LAP was increased to 5 and 10 cmH(2)O compared with that in the control group (0 cmH(2)O; 0.50 +/- 0.02 ml/h). However, alveolar fluid reabsorption decreased by approximately 50% in rat lungs in which the LAP was raised to 15 cmH(2)O (0.25 +/- 0.03 ml/h). The passive movement of small solutes ((22)Na(+) and [(3)H]mannitol) and large solutes (FITC-albumin) increased progressively in rats exposed to higher LAP. There was no significant edema in lungs with a LAP of 15 cmH(2)O when all active Na(+) transport was inhibited by hypothermia or amiloride (10(-4) M) and ouabain (5 x 10(-4) M). However, when LAP was increased to 20 cmH(2)O, there was a significant influx of fluid (-0.69 +/- 0.10 ml/h), precluding the ability to assess the rate of fluid reabsorption. In additional studies, LAP was decreased from 15 to 0 cmH(2)O in the second and third hours of the experimental protocol, which resulted in normalization of lung permeability to solutes and alveolar fluid reabsorption. These data suggest that in an increased LAP model, the changes in clearance and permeability are transient, reversible, and directly related to high pulmonary circulation pressures.

Catecholamines increase lung edema clearance in rats with increased left atrial pressure.

During hydrostatic pulmonary edema, active Na(+) transport and alveolar fluid reabsorption are decreased. Dopamine (DA) and isoproterenol (ISO) have been shown to increase active Na(+) transport in rat lungs by upregulating Na(+)-K(+)-ATPase in the alveolar epithelium. We studied the effects of DA and ISO in isolated rat lungs with increased left atrial pressure (Pla = 15 cmH(2)O) compared with control rats with normal Pla (Pla = 0). Alveolar fluid reabsorption decreased from control value of 0.51 +/- 0.02 to 0.27 +/- 0.02 ml/h when Pla was increased to 15 cmH(2)O (P < 0.001). DA and ISO increased the alveolar fluid reabsorption back to control levels. Treatment with the D(1) antagonist SCH-23390 inhibited the stimulatory effects of DA (0.30 +/- 0.02 ml/h), whereas fenoldopam, a specific D(1)-receptor agonist, increased alveolar fluid reabsorption in rats exposed to Pla of 15 cmH(2)O (0.47 +/- 0.04 ml/h). Propranolol, a beta-adrenergic-receptor antagonist, blocked the stimulatory effects of ISO; however, it did not affect alveolar fluid reabsorption in control or DA-treated rats. Amiloride (a Na(+) channel blocker) and ouabain (a Na(+)-K(+)-ATPase inhibitor), either alone or together, inhibited the stimulatory effects of DA. Colchicine, which disrupts the cellular microtubular transport of ion-transporting proteins to the plasma membrane, inhibited the stimulatory effects of DA, whereas the isomer beta-lumicolchicine did not block the stimulatory effects of DA. These data suggest that DA and ISO increase alveolar fluid reabsorption in a model of increased Pla by regulating active Na(+) transport in rat alveolar epithelium. The effects of DA and ISO are mediated by the activation of dopaminergic D(1) receptors and the beta-adrenergic receptors, respectively.

Beta-adrenergic stimulation restores rat lung ability to clear edema in ventilator-associated lung injury.

Mechanical ventilation with high tidal volume (HVT) causes lung injury and decreases the lung's ability to clear edema in rats. beta-adrenergic agonists increase active Na(+) transport and lung edema clearance in normal rat lungs by stimulating apical Na(+) channels and basolateral Na,K-ATPase in alveolar epithelial cells. We studied whether beta-adrenergic agonists could restore lung edema clearance in rats ventilated with HVT (40 ml/kg, peak airway pressure of 35 cm H(2)O) for 40 min. The ability of rat lungs to clear edema decreased by approximately 50% after 40 min of HVT ventilation. Terbutaline (TERB) and isoproterenol (ISO) increased lung edema clearance in control nonventilated rats (from 0.50 +/- 0. 02 ml/h to 0.81 +/- 0.04 ml/h and 0.99 +/- 0.05 ml/h, respectively) and restored the lung's ability to clear edema in HVT ventilated rats (from 0.25 +/- 0.03 ml/h to 0.64 +/- 0.02 ml/h and 0.88 +/- 0. 09 ml/h, respectively). Disruption of cell microtubular transport system by colchicine inhibited the stimulatory effects of ISO in HVT ventilated rats, whereas beta-lumicolchicine did not affect beta-adrenergic stimulation. The Na,K-ATPase alpha(1)- and beta(1)-subunit mRNA steady state levels were not affected by incubation with ISO for 60 min in alveolar type II cells isolated from control and HVT ventilated rats. The data suggest that beta-adrenergic agonists increased alveolar fluid reabsorption in rats ventilated with HVT by promoting recruitment of ion-transporting proteins from intracellular pools to the plasma membrane of alveolar epithelial cells.

Target organ specificity of major neuropeptide stimulants in locust excretory systems

The major stimulant of ileal fluid reabsorption in Locusta migratoria and Schistocerca gregaria corpora cardiaca, ion-transport peptide (ITP), had no stimulatory action on fluid secretion by isolated Malpighian tubules of S. gregaria, nor did it have a synergistic or antagonistic effect in combination with locustakinin (Lom-K) or Locusta-diuretic hormone (Locusta-DH). Stimulants of locust Malpighian tubules (Lom-K and Locusta-DH) had no action on either active transport of Cl(-) (measured as short-circuit current, I(sc)) or the rate of fluid reabsorption across S. gregaria ilea and recta in vitro. Thus, hormonal control of these major organs of the excretory system appears to be clearly separated. Lom-K and Locusta-DH acted synergistically to stimulate secretion by S. gregaria Malpighian tubules, and the diuretic response was more rapid than the response of the ileum and rectum to hindgut stimulants. Taken together, these data suggest that, in the initial phase of post-prandial diuresis, urine flow will exceed fluid uptake in the hindgut, thereby allowing excess water to be eliminated.

Estimation of peritoneal mass transport by three-pore model in children

Computerized modeling is increasingly used to optimize the efficacy of peritoneal dialysis (PD). The Personal Dialysis Capacity (PDC) test is a new tool to model PD efficacy based on the three-pore model of peritoneal mass transport. We sought to evaluate (i) whether the PDC test is applicable to children on chronic PD, and (ii) whether the physiological mass transport coefficients defined in the three pore model are dependent on age or body size in childhood. A validation study was performed in 32 pediatric chronic PD patients. Twenty tests were performed using a standard CAPD regimen, and 22 tests using a simplified automated PD (APD) protocol. Test accuracy and precision were evaluated by comparison of predicted with measured 24-hour dialysate clearances of urea, creatinine, beta2-microglobulin and albumin and ultrafiltration rates. Long-term reproducibility was assessed in 16 patients by repeated clearance studies after a median time interval of 10 weeks. While daily clearances of urea and creatinine were predicted with good precision and accuracy with both test protocols (concordance correlation coefficients 0.90 to 0.98, mean difference predicted-calculated -0.6 to +0.6 ml/min/1.73 m2), ultrafiltration rates were predicted more closely by the APD (r = 0.97) than by the CAPD test (0.80). Middle and large molecule clearances were predicted less precisely in both test settings (r = 0.48 to 0.83). Re-test reproducibility was slightly lower than the predictive precision observed in the original test (r = 0.80 to 0.91). The calculated total peritoneal pore area increased in absolute terms, decreased with body size when standardized to weight, and was independent of body size when normalized to body surface area. The body size-normalized fluid reabsorption rate was slightly increased in young infants compared to older children or adults. The PDC test permits to model peritoneal solute and water transport with remarkable precision in children of all age groups. While the peritoneal pore area is a linear function of body surface area, fluid reabsorption appears to be slightly increased in young infants.

Adrenal independence of fluid and electrolyte reabsorption in the ductuli efferentes testis of the rat.

The ductuli efferentes testis (efferent ducts) of the rat were studied to determine whether fluid and electrolyte reabsorption by the ducts is under the control of adrenal mineralocorticoids. Testicular fluid output and the rate of fluid reabsorption by the ducts were determined in sham-operated controls and in rats which had been adrenalectomized 10 days previously, adrenalectomized 10 days previously and given aldosterone therapy (75 micrograms kg-1 day-1 S.C.) from day 3 to day 10 post adrenalectomy, and in rats given injections of the aldosterone antagonist, spironolactone, for 10 days (10 mg kg-1 day-1 S.C.). The values for testicular fluid output and fluid flow from the efferent ducts (means +/- S.E.M.) in the sham-operated rats were 36.0 +/- 7.8 and 1.23 +/- 0.12 microliters h-1, respectively, resulting in an estimate of fluid reabsorption by the efferent ducts of 94.8 +/- 1.6% of the testicular fluid output. None of the treatments resulted in a significant change in testicular fluid output or in fluid reabsorption from the efferent ducts. Similarly, the treatments did not significantly alter the osmolality or electrolyte concentrations in fluid samples from the rete testis or the distal end of the efferent ducts (sham-operated values for rete testis and efferent duct fluid, respectively, were: osmolality, 311.2 +/- 1.7 and 302.7 +/- 5.7 mosmol kg-1; [Na+], 151.2 +/- 5.6 and 150.8 +/- 8.1 mmol l-1; [Cl-], 147.9 +/- 6.6 and 126.7 +/- 2.2 mmol l-1; [K+], 15.2 +/- 0.7 and 13.5 +/- 2.4 mmol l-1). It is concluded that, like the homologous proximal tubule of the metanephric kidney, fluid reabsorption from the efferent ducts is independent of adrenal mineralocorticoid control.

Diffusive Mass Transport Coefficients Are Not Constant During a Single Exchange In Continuous Ambulatory Peritoneal Dialysis

Mass transport coefficients usually are assumed to be constant during single 6 hr exchanges of dialysis fluid in continuous ambulatory peritoneal dialysis (CAPD). To check this assumption, the authors estimated diffusive mass transport coefficients, KBD, for five low molecular weight solutes in 34 dwell studies with glucose 3.86% (20 studies), glucose 2.27% (nine studies), and glucose 1.36% (nine studies) dialysis fluids for time periods 3-30, 30-60, 60-90, 90-120, 120-180, 180-240, and 240-360 min. Dialysate volume and the rate of fluid reabsorption were measured using radiolabeled serum albumin (RISA) as a marker. Convective transport was described using a sieving coefficient of 0.55 for all solutes. The KBD values were constant for sodium, but higher at the beginning (3-30 min) than at the end (180-360 min) of the exchanges by an average of approximately 50% for urea, creatinine, and glucose, and by approximately 120% for potassium with all three dialysis fluids. This initial increment did not depend upon the concentration of glucose in dialysis fluid, except for urea. The steady state value of KBD was reached at 120 min for all solutes. The time patterns of KBD values for urea, creatinine, glucose, and potassium were well described by an exponential decay function, with the decay constant approximately 0.02 min-1. The patterns were similar for electrically neutral solutes, but different for electrolytes. The initial increments in KBD values mean that clearances during short dwell time (30-60 min) may be higher by 5-15% than clearances calculated from the steady state KBD values.

In vivo microperfusion of the ductuli efferentes testis of the rat: flow dependence of fluid reabsorption.

Individual ducts from the initial zone of the efferent ducts of the rat were microperfused in vivo using a double cannulation procedure, which allowed the recovery of perfused fluids for analysis and determination of the rate of fluid reabsorption from the perfused duct. The ducts were perfused at rates from 0.025 to 0.4 microliters min-1 with either Krebs-Ringer bicarbonate (KRB) solution or the native rete testis fluid (nRTF) that perfuses the ducts in situ. Reabsorption of KRB solution increased linearly with a perfusion rate of between 0.025 and 0.1 microliter min-1 (from 17.4 +/- 1.5 to 34.3 +/- 3.2 nl (10 mm duct)-1 min-1), then increased no further. Reabsorption of nRTF increased linearly between 0.025 and 0.2 microliters min-1 (from 17.7 +/- 1.5 to 61.4 +/- 13.5 nl (10 mm duct)-1 min-1) and then declined. The reabsorption rate from nRTF perfusates was significantly higher than from KRB perfusates. As a proportion of the luminal perfusate, reabsorption declined from 73.0 +/- 6.0 to 7.4 +/- 3.0% (10 mm duct)-1 for KRB solution and from 73.1 +/- 6.0 to 4.1 +/- 1.3% (10 mm duct)-1 for nRTF. There was no significant change in the concentration of either Na+ or Cl- in KRB solution or nRTF during perfusion through the efferent ducts, indicating that the reabsorption of these ions was isomolar. However, the reabsorption of K+ from nRTF occurred at a greater rate than that of water, and the initial [K+] declined from 17.2 +/- 0.4 mM in nRTF perfusates to 5.7 +/- 0.5 mM in collectates (perfusion rate, 0.1 microliter min-1) to achieve equilibrium with blood plasma (4.7 +/- 0.4 mM). The osmotic pressure of both KRB and nRTF perfusates equilibrated with blood plasma, indicating a high permeability of the epithelium to water. The results of this study provide further evidence that fluid reabsorption in the efferent ducts is isosmotic, or close to isosmotic, and have shown that, as in the homologous proximal kidney tubule, reabsorption is dependent on luminal flow rate. In contrast to the proximal tubule, however, reabsorption in the efferent ducts is not maintained as a constant proportion of the perfusion load. It is concluded that microperfusion in vivo provides a useful technique for studying fluid reabsorption in the efferent ducts of the rat.

Endogenous production of angiotensin II modulates rat proximal tubule transport.

There is evidence that angiotensin II is synthesized by the proximal tubule and secreted into the tubular lumen. This study examined the functional significance of endogenously produced angiotensin II on proximal tubule transport in male Sprague-Dawley rats. Addition of 10(-11), 10(-8), and 10(-6) M angiotensin II to the lumen of proximal convoluted tubules perfused in vivo had no effect on the rate of fluid reabsorption. The absence of an effect of exogenous luminal angiotensin II could be due to its endogenous production and luminal secretion. Luminal 10(-8) M Dup 753 (an angiotensin II receptor antagonist) resulted in a 35% decrease in proximal tubule fluid reabsorption when compared to control (Jv = 1.64 +/- 0.12 nl/mm.min vs. 2.55 +/- 0.32 nl/mm.min, P < 0.05). Similarly, luminal 10(-4) M enalaprilat, an angiotensin converting enzyme inhibitor, decreased fluid reabsorption by 40% (Jv = 1.53 +/- 0.23 nl/mm.min vs. 2.55 +/- 0.32 nl/mm.min, P < 0.05). When 10(-11) or 10(-8) M exogenous angiotensin II was added to enalaprilat (10(-4) M) in the luminal perfusate, fluid reabsorption returned to its baseline rate (Jv = 2.78 +/- 0.35 nl/mm.min). Thus, addition of exogenous angiotensin II stimulates proximal tubule transport when endogenous production is inhibited. These experiments show that endogenously produced angiotensin II modulates fluid transport in the proximal tubule independent of systemic angiotensin II.

Fluid uptake from the renal medulla into the ascending vasa recta in anaesthetized rats.

1. We have investigated fluid movements between superficial ascending vasa recta (AVR) and the interstitium of exposed papillae of the renal medullae in 15-day-old Sprague-Dawley rats anaesthetized with Hypnorm and Hypnovel. 2. Using a development of the red cell micro-occlusion technique, fluid filtration and reabsorption rates per unit area of vessel wall (Jv/A) were determined in 54 single perfused AVR at known microvascular pressures (Pc). The relation between Jv/A and Pc was non-linear suggesting hydraulic permeabilities (Lp) of 50-100 x 10(-7) cm s-1 cmH2O-1 when Pc was between 0-10 cmH2O and 150-200 x 10(-7) cm s-1 cmH2O-1 when Pc was 10-15 cmH2O. 3. Rates of fluid reabsorption into the AVR estimated by a densitometric technique in a further fourteen vessels were consistent with Lp values of 50-100 x 10(-7) cm s-1 cmH2O-1 when Pc was -2 to 0 cmH2O. 4. The effective oncotic pressures of perfusates containing bovine serum albumin (BSA) were consistent with minimum values for the reflection coefficients of the walls of the AVR to BSA of between 0.59 and 0.72. 5. The concentration of native serum albumin in the papillary interstitial fluid was 9.1 +/- 0.6 mg ml-1 (mean +/- S.E.M., n = 16, from 9 rats), which is approximately 25% of the plasma level. 6. After their microinjection into the medullary interstitium, Patent Blue V and Evans Blue-albumin cleared within 1 min. There was no evidence of preferential movement of either dye towards the base of the exposed renal medulla. 7. Because Lp of the AVR is high, mean pressures of only approximately 3 cmH2O are necessary to account for the total clearance of fluid from the medullary interstitium into the AVR. From published data and from our own observations, it appears that differences in hydrostatic and oncotic pressure across the walls of the AVR are more than sufficient to provide this driving force. The possibility of the clearance of protein from the interstitium into the AVR is discussed.

Micropuncture and cannulation studies of fluid composition and transport in the ductuli efferentes testis of the rat: comparisons with the homologous metanephric proximal tubule

Luminal fluids were collected in vivo by micropuncture and cannulation from the rete testis, efferent ducts and ductus epididymidis of the rat to determine the composition of efferent duct fluids and the rates of reabsorption of water and solutes by the efferent ducts. The concentration of spermatozoa increased by a factor of about 25 from 2.42 x 10(4) microliters-1 in the fluid from the rete testis to 6.00 x 10(5) microliters-1 in fluid at the end of the efferent ducts, indicating that 96.2% of the fluid leaving the testis is reabsorbed from the lumen of the efferent ducts. Most of this reabsorption (70.9% or 33.4 microliters h-1) occurs in the region between the rete testis and the middle of the coni vasculosi, with only 25.1% (11.8 microliters h-1) occurring between the coni and the beginning of the ductus epididymidis. However, reabsorption across the epithelium occurs at about the same rate in both regions, with the proximal region reabsorbing 17.2 microliters cm-2 h-1 (70.9% of fluid entering the region) and the distal region reabsorbing 12.2 microliters cm-2 h-1 (86.1% of fluid entering the region). Consequently, the fluid reabsorption rate for the whole efferent duct system (15.6 microliters cm-2 h-1) is similar to the values for individual regions. The principal solutes in luminal fluids from the efferent ducts are Na+ (137-144 mM) and Cl- (113-130 mM). The estimated sum contribution of Na+, Cl- and K+ to the osmotic pressure of luminal fluids was approximately 80% at each site sampled in the efferent ducts. The osmotic pressure of luminal fluid samples (301-307 mosmol kg-1) did not vary significantly along the ducts or differ significantly from that of blood plasma. The results demonstrate that there is a net reabsorption in the efferent ducts of nearly all the testicular output of water and inorganic electrolytes, and most of the protein, and that, in comparison, the ductus epididymidis is a negligible site of net fluid reabsorption. The results indicate that the ductus epididymidis, rather than the efferent ducts, is the site of accumulation of high concentrations of specific organic compounds like inositol. The efferent ducts are similar to the homologous proximal tubules of the metanephric kidney in that the luminal electrolyte composition (principal solutes Na+ and Cl-) and osmotic pressure remain relatively stable and that fluid reabsorption is close to isotonic and occurs at the same rate as the reabsorption of Na+.

Glomerular Filtration Rate and Segmental Tubular Function in the Early Phase after Transplantation/Uninephrectomy in Recipients and Their Living-Related Kidney Donors

1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re-investigated. Sixteen of these constituted eight matched pairs. This reduction in the study population was caused by the application of two withdrawal criteria. 2. In the recipients glomerular filtration rate was unchanged at day 5 and had increased to 61 ml/min at day 54 (P < 0.05). In the donors glomerular filtration rate had increased to 59 ml/min by day 5 (P < 0.01) and was unchanged at day 54. 3. In the recipients lithium clearance was unchanged at day 5 and had increased to 23 ml/min at day 54 (P < 0.01). In the donors the lithium clearance had increased by day 5 (P < 0.01). 4. In the recipients the absolute proximal fluid reabsorption rate was about 36 ml/min throughout the study period. In the donors the absolute proximal fluid reabsorption rate had increased to 42 ml/min by day 5 (P < 0.05) and increased further to 44 ml/min by day 54 (P < 0.01). 5. In the recipients sodium clearance increased from 0.54 ml/min to 2.10 ml/min at day 54 (P < 0.01). In the donors it increased from 0.64 ml/min to 0.99 ml/min at day 54 (P < 0.05). 6. Donor-recipient comparison showed that at day 54 there was no significant difference with regard to glomerular filtration rate, lithium clearance, absolute and fractional proximal fluid reabsorption rate and absolute distal sodium reabsorption rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid balance versus blood flow autoregulation in the elevated human limb: the role of venous collapse.

This study evaluated the postural vascular adjustment in the human forearm which may be responsible for the recent observation that transcapillary fluid balance is maintained above the level of the heart while blood flow decreases in a linear fashion. In this study further evidence was provided that a posturally graded profile of collapsed veins holds for both an overall increase of resistance with height and compensation for hydrostatic effects on capillary pressure. This was achieved by manipulating peripheral venous profile/volume: a proximal outlet resistance (upper arm cuff) was used for re-opening of collapsed distal veins. In test (a), 12 healthy subjects underwent recordings of fluid reabsorption rate and blood flow in a 20-cm segment of their forearm horizontally placed at 36 cm above heart level (third intercostal space). Applying upper arm cuff pressures randomly between 0 and 25 mmHg (0-3.33 kPa) for 15 min led to maxima of blood flow and reabsorption rates at inflations of 5 or 10 mmHg (0.67 or 1.33 kPa). This was attributed to minima in postcapillary resistance facilitating flow and reducing capillary pressure. In test (b) the flow-maximizing outlet resistance found was studied for its effect in different forearm positions (-18, 0, 18, 36, 54 cm relative to heart level). Blood flow then showed a shift of its maximum from heart level to 36 cm above heart level, while the reabsorption rate increased above 18-cm height--in contrast to previous findings with a free circulation. It was therefore concluded that the venous profile in the forearm adjusts postcapillary resistance in such a way that local dehydration is confined at the cost of blood supply. Thicker and less collapsable veins may ensure better flow autoregulation during impaired fluid balance--as seen in the legs.