Low Urine Volume Research Articles

Should Patients with Single Renal Stone Occurrence Undergo Diagnostic Evaluation?

AbstractDiagnostic evaluation was conducted on 34 patients with a single episode of renal stone formation. Absorptive hypercalciuria was disclosed in 55.9 per cent (23.5 per cent type 1 and 32.4 per cent type II), renal hypercalciuria in 11.8 per cent, primary hyperparathyroidism in 2.9 per cent, hyperaricosuric calcium oxalate nephrolithiasis in 8.8 per cent and no metabolic abnormality in 20.6 per cent. Compared to the group with recurrent stone formation the group with a single stone episode had just as severe biochemical abnormalities or laboratory results, such as hypercalciuria and exaggerated calciuric response to oral calcium load in absorptive hypercalciuria, high fasting urinary calcium and cyclic adenosine monophosphate in renal hypercalciuria, hyperuricosuria in hyperuricosuric calcium oxalate nephrolithiasis and low urine volume in no metabolic abnormality. The results suggest that the same physiological and environmental disturbances characterize stone formation in patients with a single stone episode as in those with recurrent stone formation and indicate the need for diagnostic evaluation.

Urine culture transport tubes: effect of sample volume on bacterial toxicity of the preservative.

Stable bacterial counts in urine specimens before culture are necessary to assure the accurate diagnosis of urinary tract infections. Preservative-containing tubes are commercially available for urine transport. As these tube containers are not always filled to the manufacturer's specifications, we studied the effects of stabilizer formation with low urine volumes. The Sage Urine Culture Tube and the Becton-Dickinson Urine Culture Kit were evaluated by using 30 cultures diluted in urine to 10(5) colony-forming units per ml. Both tube types were injected with 1, 2, 3, and 4 to 5 ml (tube capacity) of urine containing each culture. Specimens were held at 22 degrees C and cultured at 0, 4, and 24 h. Colony counts were corrected for the dilution due to the preservative. The Becton-Dickinson Urine Culture Kits were toxic to Escherichia coli and Klebsiella pneumoniae in specimens containing up to 2 ml of urine, and the minimum usable amount of urine for reliable results was 3 ml. The Sage Urine Culture Tube maintained the number of bacteria in 1 to 4.5 ml of urine in 83% of the specimens. However, the Sage tube was toxic to E. coli when held for 24 h. Quantitative counts of enterococci tended to significantly increase in specimens that contained 2 ml or more of urine with either system. The limitation of preservative-containing tubes for urine transport need to be recognized in order to avoid false-positive and false-negative results.

Effect of intestinal surgery on the risk of urinary stone formation.

The prevalence of urinary stone disease in 426 patients who had undergone bowel surgery at the General Infirmary at Leeds from 1958 to 1978 was found by postal questionnaire to be 9.4%. The risk of urinary stone formation was determined from the composition of 24 hour urines from 61 unselected patients, in whom intestinal resections had been performed. There were 27 patients with an ileostomy, 17 patients with an ileostomy and a small bowel resection, and 17 patients with a small bowel resection, or bypass, and an intact colon. Of this group of 61 patients, 9.8% gave a history of urinary stones after surgery. Compared with normal control subjects ileostomy patients had significantly lower urinary pH and volume, higher concentrations of calcium, oxalate, and uric acid, and increased risk of forming uric acid and calcium stones: a small bowel resection combined with an ileostomy increased the ileostomy output, lowered the urinary volume further, and reduced urinary calcium excretion. The concentration of urinary oxalate increased and the risk of both uric acid and calcium stones was high. Patients with small bowel resection and intact colon had hyperoxaluria and an increased risk of calcium stones despite a low urinary calcium. There was no increased risk of uric acid stones in this sub-group. It is concluded that the risk of forming urinary stones after this type of surgery is considerable. The follow-up of patients with ileostomies and with small bowel resections should include an assessment of faecal losses and urinary composition to identify the patients who have a high risk of forming urinary stones.

Urolithiasis in the Sudan. Studies on a stone-prone and a stone-free population.

Biochemical studies were performed on 80 adult males with renal stones and 24 controls from Northern Sudan. Similar studies were performed on 44 controls from Southern Sudan, where urinary stones rarely occur. No significant differences between stone formers and controls from Northern Sudan were found regarding serum uric acid, phosphate, alkaline phosphatase, total protein, albumen, daily urine calcium or uric acid. Similarly, no significant difference was found between 2 groups in the incidence of hypercalciuria, hyperuricaemia of hyperuricosuria. The serum calcium was significantly higher in stone formers. The mean serum and daily urine calcium were significantly lower, and the mean serum and daily urine uric acid were significantly higher in controls from Southern Sudan compared to either stone formers or controls from Northern Sudan. The mean daily urine volume was significantly higher in Southern controls compared to Northern controls. The increased prevalence of stone formers in Northern Sudan appears to result from the higher calcium output in the urine and the lower urine volume in the North compared with the South.

Ambulatory evaluation of nephrolithiasis: Classification, clinical presentation and diagnostic criteria

Using the ambulatory protocol previously described, 241 patients with nephrolithiasis were evaluated. They could be categorized into 10 groups from the results obtained. Absorptive hypercalciuria type I (87 per cent male) comprised 24.5 per cent and was characterized by normocalcemia, normal fasting urinary calcium (< 0.11 mg/100 nil glomerular filtration), an exaggerated urinary calcium following an oral calcium load (>0.20 mg/mg creatinine), normal urinary cyclic adenosine monophosphate (AMP) (< 5.4 nmol/100 ml glomerular filtration) and serum parathyroid hormone (PTH), and hypercalciuria (>200 mg/day during a calcium- and sodium-restricted diet). Absorptive hypercalciuria type II (58 per cent male) accounted for 29.8 per cent; its biochemical features were the same as those for absorptive hypercalciuria type I, except for normocalciuria during a restricted diet and low urine volume (1.42 ± 0.55 SD liter/day). Renal hypercalciuria (56 per cent male), disclosed in 8.3 per cent, was represented by normocalcemia and high values for fasting urinary calcium (0.160 ± 0.054 mg/100 ml glomerular filtration), urinary cyclic AMP (6.80 ± 2.10nmol/100 ml glomerular filtration) and serum PTH. Primary hyperparathyroidism (57 per cent female), accounted for 5.8 per cent, typically included hypercalcemia, hypophosphatemia, hypercalciuria and high urinary cyclic AMP. Hyperuricosuric calcium urolithiasis (100 per cent male) comprised 8.7 per cent, and was characterized by hyperuricosuria (776 ± 164 mg/day) and urinary pH exceeding pK for uric acid (5.91 ± 0.33). In enteric hyperoxaluria (60 per cent female), encountered in 2.1 per cent of cases, urinary oxalate was increased (6.29 ± 13.2 mg/day). Noncalcium-containing stones were found in 2.1 per cent of the patients with uric acid lithiasis (100 per cent male) and in another 2.1 per cent of the patients with infection lithiasis (60 per cent female). These conditions were typified by low urinary pH (5.29 ± 0.12) and high urinary pH (6.69 ± 1.16), respectively. Renal tubular acidosis was found in one patient (male, 0.4 per cent). In 10.8 per cent of the patients (81 per cent male), no metabolic abnormality could be found, although urine volume was low (1.41 ± 0.51 liter/day). Hypercalciuria could not be differentiated between absorptive hypercalciuria and renal hypercalciuria in 5.4 per cent of the patients. Thus, this ambulatory protocol disclosed a physiologic disturbance in nearly 90 per cent of the cases and provided a definitive diagnosis in 95 per cent of the patients.

THE EFFECTS OF ANAESTHESIA WITH THIOPENTONE, NITROUS OXIDE, NARCOTICS AND NEUROMUSCULAR BLOCKING DRUGS ON RENAL FUNCTION IN NORMAL MAN

SUMMARY Changes in renal haemodynamics, water and electrolyte excretion were determined in 10 healthy male volunteers before and after the administration of narcotic and atropine sulphate intravenously, and after anaesthesia with thiopentone, nitrous oxide in oxygen, neuromuscular blocking drugs and in some instances intermittent narcotic. A significant reduction in glomerular filtration rate (13 per cent) without change in renal plasma flow with an increased renal vascular resistance was observed following narcotic and atropine premedication. No alteration in urine volume or osmolality followed narcotic premedication suggesting failure of ADH release. Administration of anaesthesia resulted in a further reduction (11 per cent) in glomerular filtration rate, a 31 per cent reduction in renal plasma flow and maintained increase in renal vascular resistance. A profound antidiuresis characterized by low urine volume, increased urine osmolality, and negative free water clearance was observed during anaesthesia. This could not be reversed by ethanol infusion, unlike the response in previous studies with cyclopropane and halothane.

THE EFFECTS OF ANAESTHESIA WITH THIOPENTONE, NITROUS OXIDE, NARCOTICS AND NEUROMUSCULAR BLOCKING DRUGS ON RENAL FUNCTION IN NORMAL MAN

SUMMARY Changes in renal haemodynamics, water and electrolyte excretion were determined in 10 healthy male volunteers before and after the administration of narcotic and atropine sulphate intravenously, and after anaesthesia with thiopentone, nitrous oxide in oxygen, neuromuscular blocking drugs and in some instances intermittent narcotic. A significant reduction in glomerular filtration rate (13 per cent) without change in renal plasma flow with an increased renal vascular resistance was observed following narcotic and atropine premedication. No alteration in urine volume or osmolality followed narcotic premedication suggesting failure of ADH release. Administration of anaesthesia resulted in a further reduction (11 per cent) in glomerular filtration rate, a 31 per cent reduction in renal plasma flow and maintained increase in renal vascular resistance. A profound antidiuresis characterized by low urine volume, increased urine osmolality, and negative free water clearance was observed during anaesthesia. This could not be reversed by ethanol infusion, unlike the response in previous studies with cyclopropane and halothane.

Effect of chlorothiazide on water consumption in the rat.

CHLOROTHIAZIDE has been in use for several years as a diuretic drug. Its diuretic effect is usually ascribed to inhibition of sodium reabsorption in tubular cells1. In recent years Chlorothiazide has been reported to decrease urine volume in diabetes insipidus2. The autidiurietc effect is accompanied, however, by saluresis, that is, increased sodium excretion3. To explain the paradoxical action of Chlorothiazide it has been suggested that the drug could also affect thirst, by decreasing plasma osmolarity through increased urinary sodium loss4,5. We have recently reported that Chlorothiazide reduced water intake in bilaterally nephrectomized rats, thus demonstrating an extra-renal effect6. Osmotic receptors related to thirst regulation have been postulated to be located in the hypothalamus7,8. Stein and Seifter have recently reported chemical excitation of thirst by deposition of acetyl-oholine crystals through a cannula into a certain area in the hypothalamus9. Applying their technique, we have deposited Chlorothiazide crystals in the same area of the hypothalamus of rats, weighing 350–400 g, using the co-ordinates of Stein and Seifter9. In control animals either calcium carbonate or talc was deposited in the same location. Food and water were given freely and daily consumption was recorded. Water intake was found decreased in rats with hypothalamic Chlorothiazide deposit compared with the control animals (Fig. 1). No difference in food consumption was noted between the two groups and the difference in water intake persisted also after withdrawal of the food. That Chlorothiazide was not absorbed to any appreciable extent into the circulation was suggested by the lower urinary volume in the Chlorothiazide rats relative to the control animals (20–26 per cent less). Furthermore, the potassium/sodium ratio in the urine was the same in the Chlorothiazide and the control groups.

Reversible renal potassium loss with urinary tract infection

A patient is described in whom severe potassium depletion developed with extracellular alkalosis due to defective renal conservation of potassium coupled with anorexia. Low daily urine volumes and fluid intake were features of the potassium deficiency. Aldosteronism and primary renal tubular diseases were excluded. Repeated urinary tract infections occurred and, although chronic pyelonephritis could not be diagnosed with certainty, this disease was probably the cause of the renal potassium-losing state. Normal ability to conserve potassium was regained after potassium and antibiotic therapy.

Response to adrenocorticotrophic hormone in clinical scurvy.

Summary1. Test doses of ACTH were administered to 5 patients with classical scurvy to assess their adrenal cortical activity. The test was repeated in 4 of these patients after therapy with ascorbic acid. 2. The blood eosinophil response to ACTH was that expected of individuals with normal adrenal function and did not change following treatment with ascorbic acid. 3. The urinary excretion of uric acid after ACTH was uninterpretable because of low urine volumes. 4. The blood glutathione, and the serum sodium concentrations were normal or low in these patients, but were unaltered by ascorbic acid therapy. Serum potassium concentrations were normal before and after ascorbic acid therapy. 5. To explain these evidences of normal adrenal cortical activity in scurvy, it may be postulated that either ascorbic acid is not necessary for these adrenal functions, or there was residual ascorbic acid in the adrenals of these patients.

A Simplified Method for Measurement of Creatinine Clearance

The multitude of substances whose “clearances”, or rate of excretion in relation to blood concentration, have been proposed as tests of kidney function indicates that a satisfactory clinical procedure is yet to be devised. The use of urea, as proposed by Moller, McIntosh and Van Slyke, is in our experience the simplest of the more sensitive tests, since it involves only one blood sample and does not require the ingestion of the test substance. But since the rate of urea excretion is less with low urine volume than with high, function tests can be compared only as a percentage of an average empirical normal for urine volumes above or below 2 cc. per minute. There are, therefore, certain advantages in using a test substance whose excretion is independent of urine volume. Creatinine, the use of which was proposed by Rehberg, is such a substance. This method as described has the disadvantage of requiring ingestion of creatinine, and analysis of urine and 2 samples of blood plasma. The development by Van Slyke and Cope of a clinical method for the determination of urea clearances suggested that a similar procedure might be devised for the creatinine clearance which, if practical, would considerably simplify the test. In the method of Van Slyke and Cope, the ratio between urine and blood urea concentrations is determined by a direct comparison, without determining the actual concentration in either. In the method here described, the same principle is applied except that creatinine is used. In order to increase the concentration of creatinine in the blood and urine, creatinine is administered to the subject by mouth, and water given at hourly intervals during the test if there is any question of the subject's ability to urinate.