Urinary Nitric Oxide Research Articles

Determination of urinary lipid peroxidation and nitric oxide levels in patients with upper gastrointestinal cancers in Iran

Determination of urinary lipid peroxidation and nitric oxide levels in patients with upper gastrointestinal cancers in Iran

Serum and urine nitric oxide levels in children with Henoch-Schonlein Purpura during activity and remission – a study from North India

The objective of this study is to compare serum and urine reactive nitrogen intermediates (RNI) and citrulline levels in children with Henoch-Schonlein purpura (HSP) during activity and remission. The study group consisted of 14 children with HSP. We measured serum and urine RNI and citrulline levels by spectrophotometry in the active phase of the disease and then during remission. Serum RNI levels were 303.95 ± 221.44 nmol/ml in children with active HSP and 72.57 ± 26.56 nmol/ml during remission, the differences being statistically significant (P = 0.002). Mean urine RNI levels in children with active HSP were significantly higher than that seen during remission (3.25 ± 1.80 vs. 1.68 ± 0.65 nmol/ml; P = 0.003). Similarly, serum citrulline levels during disease activity were 790.65 ± 707.87 nmol/ml as compared to 281.49 ± 307.29 nmol/ml at the time of remission, the differences being statistically significant (P = 0.002). Mean urine citrulline levels in children with active disease was 1,969.94 ± 1655.42 nmol/ml as compared to 1,099.34 ± 955.82 nmol/ml in children with remission, (P = 0.007). Serum and urine RNI and citrulline levels were significantly higher during the acute phase of HSP as compared to the levels obtained during the phase of disease remission. These findings suggest that nitric oxide may perhaps have a role in the pathogenesis of HSP. Further, these laboratory parameters could be of value in monitoring disease activity. To the best of our knowledge, this study is the most comprehensive work published on the subject so far. Our findings, however, need to be confirmed on a larger study sample before firm conclusions can be drawn.

Association of Urinary N-Domain Angiotensin I-Converting Enzyme with Plasma Inflammatory Markers and Endothelial Function

The aim of this study was to investigate the association between urinary 90 kDa N-domain Angiotensin I-converting enzyme (ACE) form with C-reactive protein (CRP) and homocysteine plasma levels (Hcy), urinary nitric oxide (NOu), and endothelial function (EF) in normotensive subjects. Forty healthy subjects were evaluated through brachial Doppler US to test the response to reactive hyperemia and a panel of blood tests to determine CRP and Hcy levels, NOu, and urinary ACE. They were divided into groups according to the presence (ACE90+) or absence (ACE90-) of the 90 kDa ACE, the presence (FH+) or absence (FH-) of family history of hypertension, and the presence or absence of these two variables FH+/ACE90+ and FH-/ACE90-. We found an impaired endothelial dilatation in subjects who presented the 90 kDa N-domain ACE as follows: 11.4% +/- 5.3% in ACE90+ compared with 17.6% +/- 7.1% in ACE90- group and 12.4% +/- 5.6% in FH+/ACE90+ compared with 17.7% +/- 6.2% in FH-/ACE90- group, P < 0.05. Hcy and CRP levels were statistically significantly lower in FH+/ACE90+ than in FH-/ACE90- group, as follows: 10.0 +/- 2.3 microM compared with 12.7 +/- 1.5 microM, and 1.3 +/- 1.8 mg/L compared with 3.6 +/- 2.0 mg/L, respectively. A correlation between flow-mediated dilatation (FMD) and CRP, Hcy, and NOu levels was not found. Our study suggests a reduction in the basal NO production confirmed by NOu analysis in subjects with the 90 kDa N-domain ACE isoform alone or associated with a family history of hypertension. Our data suggest that the presence of the 90 kDa N-domain ACE itself may have a negative impact on flow-mediated dilatation stimulated by reactive hyperemia.

ESTRADIOL INCREASES URETHRAL TONE THROUGH THE LOCAL INHIBITION OF NEURONAL NITRIC OXIDE SYNTHASE EXPRESSION

Estrogens are known to modulate lower urinary tract (LUT) trophicity and neuronal nitric oxide synthase (nNOS) expression in several organs. The aim of this study was to explore the effects of endo...

Hydroxyhydroquinone Interferes With the Chlorogenic Acid-induced Restoration of Endothelial Function in Spontaneously Hypertensive Rats

Coffee is a rich source of antioxidative polyphenols, but epidemiological studies and interventional trials have failed to demonstrate any clear beneficial effects of coffee consumption on hypertension. The interaction between hydroxyhydroquinone (HHQ) and 5-caffeoylquinic acid (CQA) was examined, in an attempt to understand the controversial effects of coffee on hypertension. Male Wistar Kyoto (WKY) rats or spontaneously hypertensive rats (SHRs, 14 weeks old) were divided into the following four groups; those on a control diet, 0.005% HHQ diet, 0.5% CQA diet, and HHQ plus CQA diet. The rats were fed the above diets for 8 weeks, and the tail arterial blood pressure was monitored in conscious rats at 2-week intervals. Urinary nitric oxide (NO) metabolites and hydrogen peroxide (H(2)O(2)) excretion were measured 8 weeks after the start of the experiment. Endothelium-dependent and -independent vasorelaxant responses and immunohistochemical staining for nitrotyrosine were examined in aortas. HHQ inhibited the CQA-induced improvement in hypertension, urinary NO metabolites or H(2)O(2) excretion, endothelial dysfunction, and nitrotyrosine deposits in aortas in SHR. However, the administration of HHQ alone had little effect on either strain. Based on the content ratio of HHQ and chlorogenic acids in coffee, HHQ interfered with the CQA-induced improvement in blood pressure and endothelial function in SHR. The results explain, at least in part, the conflicting action of coffee drinking on hypertension and vascular reactivity.

Protective effect of resveratrol on acute endotoxemia-induced nephrotoxicity in rat through nitric oxide independent mechanism

Lipopolysaccharide (LPS) is a glycolipid component of the cell wall of gram negative bacteria inducing deleterious effects on the kidney. Endotoxemia-induced nephrotoxicity is characterized by disturbed intracellular redox balance and reactive oxygen species (ROS) accumulation leading to DNA, proteins and membrane lipid damages. Resveratrol (trans-3,5,4′-trihydroxystilbene) is a polyphenol displaying antioxidant and anti-inflammatory properties. This study investigated its effects on LPS-induced nephrotoxicity in rats. Resveratrol counteracted all LPS-induced changes in renal haemodynamic parameters. In the kidney resveratrol abrogated LPS-induced lipoperoxidation and antioxidant enzyme activities depletion as superoxide dismutase (SOD) and catalase (CAT) but not peroxidase (POD) activity. LPS increased plasma and urine nitric oxide (NO) level and resveratrol reversed them. More importantly, LPS-induced iron mobilization from plasma to kidney, which was also abolished by resveratrol treatment. All these results suggest that resveratrol exerted strong antioxidant properties against LPS-induced nephrotoxicity and that its mode of action seemed to involve iron shuttling proteins.

Increased intestinal macromolecular permeability and urine nitrite excretion associated with liver cirrhosis with ascites

To determine intestinal permeability, the serum tumor necrosis factor (TNF)-alpha level and urine nitric oxide (NO) metabolites are altered in liver cirrhosis (LC) with or without ascites. Fifty-three patients with LC and 26 healthy control subjects were enrolled in the study. The intestinal permeability value is expressed as the percentage of polyethylene glycol (PEG) 400 and 3350 retrieval in 8-h urine samples as determined by high performance liquid chromatography. Serum TNF-alpha concentrations and urine NO metabolites were determined using an enzyme-linked immunosorbent assay (ELISA) and Greiss reaction method, respectively. The intestinal permeability index was significantly higher in patients with LC with ascites than in healthy control subjects or patients with LC without ascites (0.88 +/- 0.12 vs 0.52 +/- 0.05 or 0.53 +/- 0.03, P < 0.05) and correlated with urine nitrite excretion (r = 0.98). Interestingly, the serum TNF-alpha concentration was significantly higher in LC without ascites than in control subjects or in LC with ascites (198.9 +/- 55.8 pg/mL vs 40.9 +/- 12.3 pg/mL or 32.1 +/- 13.3 pg/mL, P < 0.05). Urine nitrite excretion was significantly higher in LC with ascites than in the control subjects or in LC without ascites (1170.9 +/- 28.7 micromol/L vs 903.1 +/- 55.1 micromol/L or 956.7 +/- 47.7 micromol/L, P < 0.05). Increased intestinal macromolecular permeability and NO is probably of importance in the pathophysiology and progression of LC with ascites, but the serum TNF-alpha concentration was not related to LC with ascites.

A Comparison of Aerobic Exercise and Resistance Training in Patients With and Without Chronic Kidney Disease

The morbidity and mortality associated with chronic kidney disease (CKD) are primarily caused by atherosclerosis and cardiovascular disease, which may be in part caused by inflammation and oxidative stress. Aerobic exercise and resistance training have been proposed as measures to combat obesity, inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and progression of CKD. In non-CKD patients, aerobic exercise reduces inflammation, increases insulin sensitivity, decreases microalbuminuria, facilitates weight loss, decreases leptins, and protects against oxidative injury. In nondialysis CKD, aerobic exercise decreases microalbuminuria, protects from oxidative stress, and may increase the glomerular filtration rate (GFR). Aerobic exercise in hemodialysis patients has been reported to enhance insulin sensitivity, improve lipid profile, increase hemoglobin, increase strength, decrease blood pressure, and improve quality of life. Resistance training, in the general population, decreases C-reactive protein, increases insulin sensitivity, decreases body fat content, increases insulin-like growth factor-1 (IGF-1), and decreases microalbuminuria. In the nondialysis CKD population, resistance training has been reported to reduce inflammation, increase serum albumin, maintain body weight, increase muscle strength, increase IGF-1, and increase GFR. Resistance training in hemodialysis increases muscle strength, increases physical functionality, and improves IGF-1 status. Combined aerobic exercise and resistance training during dialysis improves muscle strength, work output, cardiac fitness, and possibly dialysis adequacy. There is a need for more investigation on the role of exercise in CKD. If the benefits of aerobic exercise and strength training in non-CKD populations can be shown to apply to CKD patients as well, renal rehabilitation will begin to play an important role in the approach to the treatment, prevention, and slowed progression of CKD.

Thiazide-induced subtle renal injury not observed in states of equivalent hypokalemia

Hydrochlorothiazide (HCTZ) is used to manage hypertension and heart failure; however, its side effects include mild hypokalemia, metabolic abnormalities, and volume depletion, which might have deleterious effects on renal and endothelial function. We studied whether HCTZ cause renal injury and/or altered vasoreactivity and if these changes are hypokalemia-dependent. Rats were given a normal diet or a diet moderately low in potassium K+ with or without HCTZ. Animals fed either a low K+ diet alone or HCTZ developed mild hypokalemia. There was no significant difference in systolic blood pressure in the different treatment groups. All three groups with hypokalemia had mild proteinuria; low K(+)-HCTZ rats had reduced creatinine clearance. HCTZ-treated rats displayed hypomagnesemia, hypertriglyceridemia, hyperglycemia, insulin resistance, and hyperaldosteronism. No renal injury was observed in the groups without HCTZ; however, increased kidney weight, glomerular ischemia, medullary injury, and cortical oxidative stress were seen with HCTZ treatment. Endothelium-dependent vasorelaxation was reduced in all hypokalemic groups and correlated with reduced serum K+, serum, and urine nitric oxide. Our results show that HCTZ is associated with greater renal injury for the same degree of hypokalemia as the low K+ diet, suggesting that factors such as chronic ischemia and hyperaldosteronism due to volume depletion may be responsible agents. We also found impaired endothelium-dependent vasorelaxation was linked to mild hypokalemia.

Increased level of urinary nitric oxide metabolites in leprosy patients during Type 2 reactions and decreased after antireactional therapy

To assess the urinary nitric oxide metabolites in lepromatous patients in ENL (type 2 reactions) and to compare these metabolites after subsidence of reactions following antireactional therapy. Further to compare the levels in a group of lepromatous leprosy patients without reactions. The initial urine samples were collected from lepromatous leprosy patients when they came with ENL before commencing antireactional therapy and repeat samples were taken after resolution of ENL. Morning urine samples were collected from LL patients without reactions. Nitrites and nitrates in urine were measured using commercially available kit. Mean levels of nitric oxide metabolites of LL patients with ENL and without ENL were compared by student's 't' test. The level during ENL and after resolution was compared by paired 't' test. The nitric oxide metabolites were analyzed in 14 LL patients with ENL and after resolution of ENL and in 5 LL patients without reaction. The level of urinary nitric oxide metabolite is higher in LL patients in ENL reaction compared to LL patients without reaction (P < 0.04). These levels were reduced significantly with resolution of reaction following antireactional therapy (P < 0.004). The findings of this study suggested that the NO/NOM excretion is increased in leprosy patients during ENL episodes. With antireactional therapy (steroids) and clinical improvement the levels are reduced.

Thiazide Diuretics Exacerbate Fructose-Induced Metabolic Syndrome

Fructose is a commonly used sweetener associated with diets that increase the prevalence of metabolic syndrome. Thiazide diuretics are frequently used in these patients for treatment of hypertension, but they also exacerbate metabolic syndrome. Rats on high-fructose diets that are given thiazides exhibit potassium depletion and hyperuricemia. Potassium supplementation improves their insulin resistance and hypertension, whereas allopurinol reduces serum levels of uric acid and ameliorates hypertension, hypertriglyceridemia, hyperglycemia, and insulin resistance. Both potassium supplementation and treatment with allopurinol also increase urinary nitric oxide excretion. We suggest that potassium depletion and hyperuricemia in rats exacerbates endothelial dysfunction and lowers the bioavailability of nitric oxide, which blocks insulin activity and causes insulin resistance during thiazide usage. Addition of potassium supplements and allopurinol with thiazides might be helpful in the management of metabolic syndrome.

The role of nitric oxide in diabetes-induced changes of morphine tolerance in rats

Several neuroendocrine complications including diabetes change the morphine antinociception and the development of tolerance to the drug. Morphine antinociception was reduced significantly in morphine tolerant diabetic rats compared to the non-diabetic animals. The exact mechanism of this effect is not known. This study was performed to determine the role of nitric oxide (NO) on morphine tolerance in diabetic state. Nociceptive responses in alloxan-induced diabetic morphine tolerated rats were measured by the hot-plate test. The urinary nitric oxide level was measured spectrophotometrically with Griess reagent. For the conversion of nitrate to nitrite, vanadium chloride was used. The results showed that experimental diabetes increased morphine analgesia. Conversely, degree of tolerance to morphine was diminished in diabetic state. The urinary nitrite content in diabetic morphine tolerated rats was higher than non-diabetic groups. L-arginine significantly increased the NO production in diabetic morphine tolerated animals, whereas aminoguanidine decreased it. Appropriately, L-arginine increased the latency time of reaction to noxious stimuli in diabetic compared to non-diabetic rats. L-arginine-treated animals also showed more tolerance to morphine analgesia. As expected, aminoguanidine deducted the level of morphine tolerance in diabetic animals. It is suggested that NO has a modulatory role in the effects of diabetes on morphine analgesia and tolerance.

Cyclophosphamide Induced Cystitis: Role of Nitric Oxide Synthase, Cyclooxygenase-1 and 2, and NK 1 Receptors

The role of substance P, inducible nitric oxide synthase, and cyclooxygenase-1 and 2 on the pathogenesis of cyclophosphamide induced cystitis was investigated in rats. Sprague-Dawley male rats received 1 of certain treatments, including 1) 0.9 weight per volume saline (0.10 ml/100 gm intraperitoneally), 2) cyclophosphamide (75 mg/kg intraperitoneally), 3) cyclophosphamide plus the NK(1) receptor antagonist Win-51.708 (20 mg/kg intraperitoneally), 4) cyclophosphamide plus the inducible nitric oxide synthase inhibitor S-methylthiourea (20 mg/kg intraperitoneally), 5) cyclophosphamide plus the highly selective cyclooxygenase-2 inhibitor rofecoxib (15 mg/kg intraperitoneally), 6) cyclophosphamide plus the selective cyclooxygenase-2 inhibitor meloxicam (15 mg/kg intraperitoneally), 7) cyclophosphamide plus the nonselective cyclooxygenase inhibitor ketoprofen (20 mg/kg intraperitoneally) or 8) cyclophosphamide plus methylthiourea plus meloxicam. Parameters were evaluated 6 hours after cyclophosphamide administration, including plasma protein extravasation, histological changes, myeloperoxidase and inducible nitric oxide synthase activities in the bladder, plasmatic nitric oxide metabolites and urinary nitric oxide metabolites, and prostaglandin E(2) levels. Cyclophosphamide produced inflammatory and cytotoxic changes in the bladder, accompanied by increased nitric oxide metabolites, urinary prostaglandins, myeloperoxidase and inducible nitric oxide synthase activity. Pretreatment with Win-51.708 and with methylthiourea prevented all of these effects except myeloperoxidase activity, which was only prevented by Win-51.708. All inducible cyclooxygenases were able to prevent prostaglandin synthesis and increases in myeloperoxidase activity. Combined inhibition of inducible nitric oxide synthase and cyclooxygenase-2/cyclooxygenase-1 (methylthiourea plus meloxicam) did not provide any additional protection against bladder damage, increased inducible nitric oxide synthase activity or prostaglandin E(2) synthesis. Additionally, this combination was unable to prevent increased myeloperoxidase activity. The results of this study suggest that there is crosstalk between nitric oxide and the cyclooxygenase enzyme with cyclooxygenase-1/cyclooxygenase-2 isoforms having an important role in this relationship. Augmented myeloperoxidase activity seems to be associated with NK(1) receptor activation and low levels of nitric oxide with cyclooxygenase-1 having an important role.

Dosing time-dependent variation of bone resorption by cyclosporin A in rats’ femurs

The dosing time-dependent difference of bone resorption by cyclosporin A was determined in normal rats. Rats were kept in rooms with a 12-h light/dark cycle. Cyclosporin A (3 mg/kg, once a day) or vehicle was given at either 2 h after light on (2 HALO) or 8 HALO, 14 HALO, 20 HALO for 24 weeks. Serum and 4-h urine samples were obtained before and at 12 and 24 weeks after the treatment. Body weight, creatinine clearance, serum parathyroid hormone, the trough level of cyclosporin A in whole blood and urinary excretion of Ca and P were not changed by the drug at every any dosing time. Serum Ca and P concentrations by the vehicle treatment differed with the dosing time. Furthermore, increases of these two parameters by the drug varied with dosing time; most prominently at the 2 HALO dosing, and were not seen at the 8 and 14 HALO dosings. Degree of bone resorption of the femur determined by dual-energy X-ray absorption, also varied with dosing time, most prominently at 2 HALO and less prominently at 14 HALO. Increase of urine deoxypyridinoline excretion, a marker of osteoclast activity, by the drug was highest at 2 HALO and lowest at 14 HALO, however parathyroid hormone and osteocalcin concentrations after cyclosporin A treatment did not vary with dosing time. Reduction of urinary nitric oxide (NO) was most prominent at 2 HALO and negligible at 14 HALO. We concluded that cyclosporin A-induced bone resorption and serum Ca and P increases were varied with dosing time. Sensitivity of osteoclasts by the drug was the major mechanisms of the phenomenon, while differences in pharmacokinetics, the parathyroid gland, osteoblasts and renal handling of Ca and P did not contribute to the phenomenon.

The Driselase-treated fraction of rice bran is a more effective dietary factor to improve hypertension, glucose and lipid metabolism in stroke-prone spontaneously hypertensive rats compared to ferulic acid

The aim of this study is to investigate the effects of dietary supplementation with the Driselase-treated fraction (DF) of rice bran and ferulic acid (FA) on hypertension and glucose and lipid metabolism in stroke-prone spontaneously hypertensive rats (SHRSP). Male SHRSP at 4 weeks of age were divided into three groups, and for 8 weeks were fed (1) a control diet based on AIN-93M, (2) a DF of rice bran-supplemented diet at 60 g/kg and (3) an FA-supplemented diet at 0.01 g/kg. Means and standard errors were calculated and the data were tested by one-way ANOVA followed by a least significance difference test. The results showed that both the DF and FA diets significantly improved hypertension as well as glucose tolerance, plasma nitric oxide (NOx), urinary 8-hydroxy-2'-deoxyguanosine and other parameters. In particular, compared to the FA diet, the DF diet produced a significant improvement in urinary NOx, hepatic triacylglycerol and several mRNA expressions of metabolic parameters involved in glucose and lipid metabolisms. The results of the metabolic syndrome-related parameters obtained from this study suggest that the DF diet is more effective than the FA diet.

Changes in Urinary Nitric Oxide in Pediatric Renal Diseases

목적 : 본 연구는 소아신장질환에서 소변 내 산화질소(NO)의 배설이 변화 되는가 또한 소변 내 NO가 소아 신장질환의 조직학적 원인 및 섬유화 여부를 추정하는데 사용될 수 있는가를 알아보았다. 방법 : 고대구로병원 소아신장 클리닉에 다니는 방광 요관 역류(VUR) 환아 16명, 미세 변화신 증후군(MCNS) 환아 32명을 대상...

Nitric oxide mediates collecting duct endothelin‐1 effects on blood pressure

Collecting duct (CD)-derived endothelin-1 (ET-1) modulates systemic blood pressure (BP) and Na excretion, but the mechanisms by which ET-1 exerts these effects are poorly understood. To address this, mice with CD-specific ET-1 knockout (CD ET-1 KO) and controls were studied (n=6–8). On a normal (0.3%) Na diet, systolic BP (radiotelemetry) in CD ET-1 KO mice was 19 ± 3 mmHg greater than controls. L-NAME (1 mg/ml drinking water) administration for 3 days increased BP in CD ET-1 KO by 11 ± 2 mmHg and in control mice by 28 ± 4 mmHg, thereby abolishing the difference in BP between the two groups. High (4%) Na diet ± L-NAME increased BP by 10 ± 3 mmHg in both groups. Urinary nitric oxide (NO) (nitrate+nitrite) excretion was reduced by 23 ± 4 % in CD ET-1 KO, as compared to control, mice on a normal or high Na diet. In acute studies wherein renal perfusion pressure was controlled at two different levels, urine volume and NO excretion rate were reduced in CD ET-1 KO mice as compared to controls at both perfusion pressures. Measurement of NO synthase (NOS) 1, 2 and 3 activity in inner medullae revealed reduced NOS3 activity in CD ET-1 KO mice on a normal Na diet, while NOS1 and NOS3 activities were decreased in CD ET-1 KO mice on a high Na diet when compared to control mice, respectively. In conclusion, these data suggest that hypertension in CD ET-1 KO mice is due to reduced renal NO production, the latter due, at least partially, to decreased medullary NOS activity.

The Obese Diabetic Zucker fa/fa Rat has higher urinary nitric oxide levels compared to their lean littermates.

Diabetes is reaching epidemic proportions, with a worldwide prevalence of 150 million persons. Renal disease in patients with type 2 diabetes is the leading cause of terminal renal failure and a major health care problem. There is a need to explore gender differences in the progression of type 2 diabetes, its complications, and the response to therapy. We are using the obese Zucker (fa/fa) rat as a model for type 2 diabetes associated with obesity. Renal function, including glomerular filtration rate (GFR) as measured by iohexol clearance, plasma glucose and urinary nitric oxide levels were measured in both males and females at 20 weeks of age. Body weight, blood glucose and blood pressure were increased, and GFRs decreased, in the obese males and females compared to the lean controls. Despite the fact that blood glucose in the obese females was half that in the obese males, GFRs were the same in both these groups. Alterations in levels of nitric oxide (NO) can lead to the formation of peroxynitrites and potent reactive oxygen and nitrogen species. Therefore, an optimal combination of antioxidant nutrients to alleviate the burden of oxidative stress in diabetic patients would be beneficial. Our next step is to examine the effect of an antioxidant fortified diet on renal function and the expression of nitric oxide synthases (NOSs) in diabetic male and female Zucker rats, to determine if there is a gender related response to therapy. The ultimate goal of these studies is to establish better therapies that may include antioxidants, to prevent the long term complications of diabetes.

Serum and Urinary Nitrites and Nitrates and Doppler Sonography in Children With Diabetes

The aim of the present study was to evaluate serum and urinary nitric oxide (NO) concentrations in children and adolescents with diabetes compared with age-matched healthy control subjects to find out whether Doppler ultrasonography could be used to detect changes in renal resistive indexes (RIs) in children with diabetes and to assess whether there are correlations between these parameters and NO excretion. We studied 42 children with type 1 diabetes and 41 matched healthy control subjects, both divided into prepubertal or pubertal children. Serum and urinary nitrite and nitrate (NO2-+NO3-) concentrations were evaluated as an index of NO production. Doppler ultrasonographic registration of intrarenal RI was performed. Compared with healthy control subjects, children with diabetes had significantly increased concentrations of serum (30.26 +/- 6.52 vs. 24.47 +/- 7.27 mmol/l, P = 0.001) and urinary NO2-+NO3- (345.07 +/- 151.35 vs. 245.86 +/- 80.25 mmol/l, P = 0.002); the same was true for Doppler RI values (0.64 +/- 0.03 vs. 0.60 +/- 0.04, P = 0.035). This occurs in both prepubertal and the pubertal children. A significant positive correlation was found between serum and urinary NO2-+NO3- levels (P = 0.002, r = 0.374). Serum NO2-+NO3- concentrations also correlated positively with Doppler RI (P = 0.032, r = 0.262) and HbA1c (A1C) (P = 0.004, r = 0.329); urinary NO2-+NO3- concentrations correlated positively with A1C (P = 0.001, r = 0.394). Doppler RI correlated positively with A1C (P = 0.000, r = 0.424). This study demonstrates that in children with diabetes, chronic hyperglycemia may act through a mechanism that involves increased NO production and/or action and contributes to generating intrarenal hemodynamic abnormalities, which are detectable by Doppler ultrasonography even in early diabetic nephropathy.

Higher Urine Nitric Oxide Is Associated with Improved Outcomes in Patients with Acute Lung Injury

Nitrogen oxide (NO) species are markers for oxidative stress that may be pathogenic in acute lung injury (ALI). We tested two hypotheses in patients with ALI: (1) higher levels of urine NO would be associated with worse clinical outcomes, and (2) ventilation with lower VT would reduce urine NO as a result of less stretch injury. Urine NO levels were measured by chemiluminescence in 566 patients enrolled in the National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Network trial of 6 ml/kg versus 12 ml/kg VT ventilation. The data were expressed corrected and uncorrected for urine creatinine (Cr). Higher baseline levels of urine NO to Cr were associated with lower mortality (odds ratio, 0.43 per log(10) increase in the ratio), more ventilator-free days (mean increase, 1.9 d), and more organ-failure-free days (mean increase, 2.3 d) on multivariate analysis (p < 0.05 for all analyses). Similar results were obtained using urine NO alone. NO to Cr levels were higher on Day 3 in the 6 ml/kg than in the 12 ml/kg VT group (p = 0.04). Contrary to our hypothesis, higher urine NO was associated with improved outcomes in ALI at baseline and after treatment with the 6 ml/kg VT strategy. Higher endogenous NO may reflect less severe lung injury and better preservation of the pulmonary and systemic endothelium or may serve a protective function in patients with ALI.