Total Urine Research Articles

65 Evaluation of Calcium to Phosphorus Ratio in Spot Urine Samples as a Practical Method to Monitor Phosphorus Intake Adequacy in Sows

Abstract The reliability of spot urinary Ca to P ratio (uCa:P) to assess P intake adequacy in sows was evaluated. Thirty-six multiparous sows were fed one of six concentrations of dietary total P (0.40, 0.48, 0.56, 0.64, 0.72, and 0.80%), with a constant Ca to total P ratio (1.25:1), from day 7.5+1 after breeding until the end of lactation (day 26.6+1). Total 24-hour urine samples were collected in mid (day 77.1+2) and late gestation (day 112.4+1), and early (day 4.5+1 and late (day 18.2+1) lactation. In parallel to 24-hour collections, spot urine samples were collected at three times (early morning, late morning, and late afternoon) in late gestation and late lactation. Urine Ca and P concentrations were measured and uCa:P was calculated. Sows were classified as P-adequate or P-deficient according to dietary P intake. Sows fed P-deficient diets had greater uCa:P than sows fed P-adequate diets (P < 0.001). Receiver operator characteristic (ROC) curves were used to determine cut-off values for uCa:P to predict P intake adequacy. The area under the ROC for uCa:P was 0.88 (95% CI 0.81–0.95). Best cut-off value of uCa:P was 1.5 (sensitivity 94% and specificity 68%) to identify sows fed P-deficient diets, and 0.5 for P-excessive diets (sensitivity 82% and specificity 82%). A strong relationship between uCa:P in 24-hour and spot urine samples was determined (r = 0.93, P < 0.01), independent of physiological state and collection time of spot samples (adjusted-R2 = 0.86, P < 0.01). The degree of agreement between spot and 24-hour urine for P intake adequacy, assessed by Cohen’s weighted kappa analysis, was substantial (0.78, 95% CI 0.69–0.88). Measurements of uCa:P in spot urine samples provide a reliable prediction of the adequacy of P intake in reproducing sows. Values of uCa:P > 1.5 were associated with P-deficient diets, whereas uCa:P < 0.5 reflected excessive P intake.

Management of Pheochromocytoma in a Patient With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Background: There are few guidelines for the management of patients with both significant cardiac valvular disease and pheochromocytoma. Resection of pheochromocytoma is challenging for surgeons and anesthesiologists due to the potential for sudden releases of catecholamines causing significant hemodynamic effects. The cornerstone of perioperative management of pheochromocytoma involves alpha blockade to prevent the potential for hypertensive crisis from unopposed alpha-adrenergic vasoconstriction. Achieving adequate adrenergic blockade is challenging in patients with aortic stenosis due to the risks of decreased afterload precipitating myocardial ischemia and bradycardia leading to diminished cardiac output [1]. It is difficult to determine whether to proceed first with transcatheter aortic valve replacement or pheochromocytoma resection in patients with both conditions. Clinical Case: An 83-year-old woman with a past medical history of type 2 diabetes, essential hypertension, coronary artery disease, and severe aortic stenosis was found to have a left adrenal mass (10.7 cm) on coronary CTA during pre-operative evaluation for transcatheter aortic valve replacement. She had significantly elevated total urine metanephrines of 16,237 ug/24 hr (n 140–785 ug/24 hr); other hormonal workup was unremarkable. A multi-disciplinary team of interventional cardiology, anesthesiology, and endocrinology specialists determined the safest management plan involved proceeding with transcatheter aortic valve replacement, after adequate alpha and beta blockade and prior to pheochromocytoma resection, to avoid potential for severe heart failure. Due to the potential for unpredictable catecholamine release intra and peri-operatively, the patient was at high risk for hypertensive crisis and mortality. Her home medications of metoprolol 50 mg twice daily, spironolactone 25 mg daily, and verapamil 120 mg daily were continued. She was started on treatment with phenoxybenzamine 10 mg in morning and 10 mg in evening. The phenoxybenzamine dose was titrated to 10 mg in the morning and 20 mg in the evening to achieve a consistent systolic blood pressure of less than 130 mm Hg. She successfully underwent transcatheter aortic valve replacement and remained hemodynamically stable. She was discharged with plan for surgical resection of pheochromocytoma six weeks after her transcatheter aortic valve replacement. Conclusions: This case describes a successful management strategy for achieving alpha blockade in an elderly patient with pheochromocytoma and severe aortic stenosis. Reference: [1] Saran JS, Moalem J, Schoeniger L, Tzimas K. Perioperative Management of Pheochromocytoma Resection in a Patient With Severe Aortic Stenosis. J Cardiothorac Vasc Anesth. 2018 Dec;32(6):2712–2715.

Paraganglioma

Introduction: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal medullary neural crest derivatives. The terms pheochromocytoma and paraganglioma are often used interchangeably because morphologically and functionally these entities are almost the same. However, paragangliomas that arise in the adrenal medulla are called pheochromocytomas and those outside the adrenal gland are called paragangliomas. Paragangliomas are often discovered incidentally during imaging studies performed for other reasons. We report a case of a patient who had incidental finding of retroperitoneal paraganglioma on imaging done for evaluation of thigh and gluteal cellulitis. Clinical Case: A 24-year-old female presented with chief complaints of episodic headaches, multiple skin abscesses, fever and malaise. She has a history of Type 1DM and had been non-compliant on insulin. Vitals on presentation was significant for tachycardia with heart rate of 124, blood pressure of 119/81, respiratory rate of 16. Initial labs were consistent with DKA. CT abdomen and pelvis done for further evaluation of gluteal and thigh abscess showed incidental finding of a 3.4 cm retroperitoneal/para-aortic well-circumscribed rim-enhancing mass with central hypoenhancing component, suspicious for neoplasm such as paraganglioma. Biochemical testing was performed. 24-hour urine catecholamine levels obtained showed elevated urine norepinephrine level of 1008μg/day (reference range 15-100μg/day), urine dopamine 410μg/day (reference range 65- 400μg/day), urine epinephrine less than 2μg/day (reference range 0-20μg/day). Total urine catecholamines was elevated 1008μg/day (reference range 15-100μg/day). These results confirmed diagnosis of paraganglioma. Treatment options were discussed with the patient including surgery for removal of paraganglioma which she has currently declined. Conclusion: Diagnosis of a paraganglioma can usually be made using biochemical and radiographic testing. All patients with paraganglioma should be tested for hypersecretion of catecholamines in a 24-hour urine or serum collection, even if they do not present with a clinical picture of catecholamine hypersecretion. Importantly these extra-adrenal tumors do not have the enzymatic capacity to form epinephrine from norepinephrine as was exemplified by our case. For catecholamine-secreting tumors, biochemical diagnosis should be followed by radiological evaluation (typically either CT or MRI of the abdomen and pelvis) to locate the tumor. Treatment options are dependent on location of tumor, size, presence of symptoms and if there is metastatic disease present.

Effect of oat particle size on energy and nutrient utilization in growing pigs.

An experiment was conducted to determine the energy content of oats and to investigate the effects of oat particle size on nutrient and energy balance in growing pigs. Eighteen barrows (23.56 ± 0.94 kg initial body weight) were randomly assigned to one of the three dietary treatments with six replicates per treatment. Whole oats were ground with a hammermill fitted with 4.8- and 3.2-mm screens to make coarse and medium particle size oats, respectively. Medium oats were further ground with a rotary steel cutting grinder fitted with a 2.0-mm screen, and the further ground oats were mixed with medium oats in a 1:3 ratio to make fine oats. Three experimental diets consisted of 96.3% of the coarse, medium, or fine oats as a sole source of energy were used. Pigs were fed diets for 16 d, including 10 d for adaptation and 6 d for total fecal and urine collection. Pigs were then moved into indirect calorimetry chambers to determine 24-h heat production and 12-h fasting heat production. All data were analyzed using the MIXED procedure of SAS with the individual pig as the experimental unit. The geometric mean particle sizes for coarse, medium, and fine oats were 765, 619, and 569 μm, respectively. Pigs fed the medium oats diet tended to have (P < 0.10) greater apparent total tract digestibility (ATTD) of starch, neutral detergent fiber, and gross energy than those fed coarse oats diet. The medium oats diet contained greater (P < 0.05) digestible energy (DE), metabolizable energy (ME), and net energy (NE) than the coarse oats diet. Pigs fed the fine oats diet had lower (P < 0.05) ATTD of Ca and P than those fed the coarse oats diet. The DE, ME, and NE contents of fine oats were comparable with those of coarse oats. The determined NE contents for coarse, medium, and fine oats were 2,335, 2,615, and 2,521 kcal/kg on a dry matter basis, respectively. The NE content in medium oats was greater (P < 0.05) than the NE values predicted using published equations. In conclusion, it was suggested to grind whole oats for 619 μm concerning energy utilization. Further grinding to 569 μm reduces Ca and P digestibility.

50 Intake, digestibility, and nitrogen balance in horses fed rhizoma peanut hay

Rhizoma peanut hay has the potential to meet horses’ crude protein requirements with reduced nitrogen excretion. This study aimed to evaluate nutrient intake, apparent digestibility, and nitrogen balance of rhizoma peanut (RP, Arachis glabrata cv Florigraze) hay compared with alfalfa (ALF, Medicago sativa L. cv Legendary XHD) and bermudagrass (CB, Cynodon dactylon L. cv Coastal) hays when fed to maintenance horses at 2% BW/d on a dry-matter (DM) basis. Six mature Quarter Horse geldings (593 ± 40 kg; mean ± SD) were randomly assigned to one of the hays in a replicated 3 × 3 Latin square with 21-d periods. A 14-d adaptation phase was followed by a 3-d total fecal and urine collection. Intake of nutrients is reported on a DM basis. Both legumes (ALF = 1.99% BW and RP = 1.97% BW) provided DM intake greater ( P < 0.05) than CB (1.82% BW) but were not different from one another. Digestible energy (DE) intake of ALF (29.9 Mcal/d) and RP (29.4 Mcal/d) were greater ( P < 0.05) than CB (20.8 Mcal/d). Crude protein (CP) intake was greater ( P < 0.05) for ALF (2,542 g/d), followed by RP (1,859 g/d), and then CB (1,477 g/d). Alfalfa provided the highest ( P < 0.05) calcium to phosphorus ratio of 6.3:1, while RP provided 4.4:1, and CB provided the lowest (1.7:1). Intake of all hays exceeded maintenance DE, CP, Ca, and P requirements. Apparent DM ( P < 0.05) and CP ( P < 0.05) digestibility were greater for ALF (69%, 84%), followed by RP (61%, 72%), and lowest for CB (46%, 64%). Neutral detergent fiber apparent digestibility did not differ ( P = 0.2228) among the 3 hays, while acid detergent fiber digestibility ( P = 0.0054) was lower for RP and similar for ALF and CB. Apparent digestibility of non-structural carbohydrate ( P < 0.05) was greater for ALF, followed by RP, and lowest for CB, while starch ( P < 0.05) digestibility was similar between the legumes and lowest for CB. Water intake for ALF was greater ( P < 0.05) than RP and CB. Greater urinary excretion ( P < 0.05) was observed for alfalfa, while water excreted through feces was greater ( P < 0.05) for CB, followed by RP, and lower for ALF. Urinary nitrogen (N) excretion was greater ( P < 0.05) for ALF, followed by RP, and lower for CB whereas fecal N excretion for both RP and CB were greater ( P < 0.05) than for ALF. Total N excreted was greater ( P < 0.05) for ALF (278 g/d), followed by RP (211 g/d), and lower for CB (179 g/d). Nitrogen retention was greater ( P < 0.05) for ALF when represented as g/d, but similar to RP when presented as percent of N intake. Results indicate that rhizoma peanut hay is a suitable legume for horses by meeting DE and CP requirements with significantly less N excretion than alfalfa.

Nalfurafine Combined with Standard‐of‐Care Diuretics Increases Diuresis and Limits Electrolyte Losses

Kappa opioid receptor (KOR) agonists produce a variety of beneficial effects, including a water diuresis, but their translation into the clinic has been hindered by psychotomimetic adverse effects. Nalfurafine is a novel, G protein biased KOR agonist that has been shown to produce several desired effects of KOR agonists, while avoiding central adverse effects. To more fully explore the clinical potential of this drug, this study examined the cardiovascular and renal responses to i.v. nalfurafine alone or in combination with the clinically used diuretics: furosemide, hydrochlorothiazide (HCTZ), and amiloride. Following chronic instrumentation, conscious Sprague-Dawley rats were continuously infused i.v. with isotonic saline; after stabilization, rats were administered i.v. bolus nalfurafine, diuretics, diuretics combined with nalfurafine, or vehicle, and mean arterial pressure (MAP), heart rate (HR), and urine output were recorded for 90 min. IV nalfurafine produced a marked diuresis, antinatriuresis, antikaliuresis, and decrease in MAP without eliciting a change in HR. As compared to diuretic treatment alone, co-administration of nalfurafine notably increased the total urine output to furosemide and HCTZ while reducing the amount of sodium and potassium excreted. When combined with amiloride, nalfurafine also increased the diuresis and decreased the amount of sodium excreted. In contrast to these diuretics administered alone, MAP was reduced with nalfurafine combination therapy. Together, these findings demonstrate that nalfurafine has a clinically important action to augment the diuresis to classical diuretics without causing excessive loss of electrolytes characteristic of these drugs. Combination therapy of nalfurafine with loop/thiazide diuretics may offer a new approach to treat several cardiovascular conditions such as hypertension, volume overloaded states, and electrolyte abnormalities.

Evaluation of energy values of high-fiber dietary ingredients with different solubility fed to growing pigs using the difference and regression methods.

The objective of this study was to compare the energy values of high-fiber dietary ingredients with different solubility (sugar beet pulp [SBP] and defatted rice bran [DFRB]) in growing pigs using the difference and the regression methods. A total of 21 barrows (initial BW, 40.5 ± 1.2 kg) were assigned to 3 blocks with BW as a blocking factor, and each block was assigned to a 7 × 2 incomplete Latin square design with 7 diets and two 13-d experimental periods. The 7 experimental diets consisted of a corn-soybean meal basal diet and 6 additional diets containing 10%, 20%, or 30% SBP or DFRB in the basal diet, respectively. Each of the experimental periods lasted 12 d, with a 7 d dietary adaptation period followed by 5-d total fecal and urine collection. Results showed that the digestible energy (DE) and metabolizable energy (ME) of the SBP determined by the difference method with different inclusion levels (10%, 20%, or 30%) were 2,712 and 2,628 kcal/kg, 2,683 and 2,580 kcal/kg, and 2,643 and 2,554 kcal/kg DM basis, respectively. The DE and ME in the DFRB evaluated by the difference method with 3 different inclusion levels were 2,407 and 2,243 kcal/kg, 2,687 and 2,598 kcal/kg, and 2,630 and 2,544 kcal/kg DM basis, respectively. Different inclusion levels had no effects on the energy values of each test ingredient estimated by the difference method. The DE and ME of the SBP and the DFRB estimated by the regression method were 2,562 and 2,472 kcal/kg and 2,685 and 2,606 kcal/kg DM basis, respectively. The energy values of each ingredient determined by the regression method were similar to the values estimated by the difference method with the 20% or 30% inclusion level. However, the energy values of the SBP and DFRB estimated by the difference method with the 10% inclusion level were inconsistent with the values determined by the regression method (P < 0.05). In conclusion, the regression method was a robust indirect method to evaluate the energy values for high-fiber ingredients with different solubility in growing pigs. If the number of experimental animals was limited, the difference method with a moderate inclusion level (at least 20%) of the test high-fiber ingredient in the basal diet could be applied to substitute the regression method.

Nitrate and nitrite absorption, recycling and retention in tissues of sheep

Dietary nitrate is of increasing interest both for the pharmacological effects of its metabolites as well as its capacity to inhibit methanogenesis in the gut. A sequence of three experiments was conducted to investigate the absorption, metabolism and excretion of nitrate and nitrite through the gastrointestinal tract (GIT) of sheep, and to determine the fate of nitrate and nitrite in body fluids, tissues and faeces after intravenous dosing with 15N-labeled potassium nitrate (K15NO3) and with 15N-labeled sodium nitrite (Na15NO2). In Experiment 1, twelve female Merino sheep were assigned to one of two dietary treatments and adapted to the experimental diet over two weeks. Six sheep were fed a control diet of wheaten chaff mixture (600 g wheaten chaff plus 200 g wheat grain, CON) and six sheep were fed the CON diet with the inclusion of 18 g nitrate/kg DM (Nitrate). After acclimation to the diets, all sheep received a single intravenous dose of K15NO3 and were placed in metabolic cages for daily collection of total faeces and urine over 6 days. Experiment 2 studied movement of an intravenous dose of 15N in body fluids and tissues. Two sheep not adapted to dietary nitrate were dosed intravenously with K15NO3 or Na15NO2 and body fluids and tissue samples were collected 60 min after dosing. Finally, Experiment 3 was conducted to identify and quantify the major sites of nitrate and nitrite transfer within the body, focusing on absorption, partitioning and secretion into the GIT of anaesthetised sheep. A single dose of sodium nitrate (NaNO3) or sodium nitrite (NaNO2) was introduced into the rumen or abomasum or small intestine, and changes in nitrate and nitrite concentrations in other pools, including plasma, urine and saliva, were determined. Results from Experiment 1 showed that urinary recovery of 15N dose in urea after 46 h and total urinary recovery of 15N 141 h after dosing were greater in sheep fed the Nitrate diet relative to CON (P < 0.05). Recoveries of 15N in tissues indicated that nitrate and nitrite principally accumulated in the skin and muscle of sheep (Experiment 2). Finally, Experiment 3 indicated that nitrate and nitrite were rapidly absorbed from the rumen, abomasum and small intestine into the bloodstream. Nitrite was oxidized in plasma and the resultant nitrate was concentrated and recycled via saliva. Appearance of 15N in urinary urea confirmed the passage of plasma nitrate to the digestive tract, via saliva or transruminal flow to be reduced by gut biota to ammonia.

Evaluation on Net Energy of Defatted Rice Bran from Different Origins and Processing Technologies Fed to Growing Pigs

Simple SummaryIn recent years, prices of imported staples such as corn and soybean meal have risen dramatically. Defatted rice bran (DFRB), an abundant and underutilized agricultural coproduct of the paddy rice, was a replacement of corn and soybean meal. It is necessary to comprehensively evaluate the nutritional value of DFRB. This study determined and compared the net energy (NE) of DFRB from different sources and different processing technology fed to growing pigs using indirect calorimetry. Results indicated that NE contents of extruded DFRB from different provinces were within the range of values ((8.24 to 10.22 MJ/kg dry matter (DM)). The NE contents of extruded DFRB and pelleted DFRB from the same province were 8.24 vs. 6.56 MJ/kg DM. This study showed that there is a discrepancy of approximately 10.01% in the NE content between the DFRB origins. The data above suggested that NE content of DFRB could be related to DFRB origins and processing technology. More NE contents of different DFRB samples deserve to be explored further. The study supported some theoretical foundation for the application of DFRB in the NE system.The study was conducted to determine and compare the net energy (NE) of defatted rice bran (DFRB) from different sources and different processing technology fed to growing pigs using indirect calorimetry. Thirty-six growing barrows (30.7 ± 3.9 kg) were randomly allotted to 1 of 6 diets with 6 replicate pigs per diet. Diets included a corn-soybean meal basal diet and 5 test diets containing 30% DFRB, respectively. These five samples come from 4 different provinces (i.e., Heilongjiang, Jiangsu, Jilin, and Liaoning province within China) and two of them with the same origin but different processing technologies (i.e., extruded or pelleted). During each period, pigs were kept individually in metabolism crates for 21 days, including 14 days to adapt to the diets. On day 15, pigs were transferred to the open-circuit respiration chambers for adaptation, and the next day were ready to determine daily total heat production (HP) and were fed 1 of the 6 diets at 2.3 MJ metabolizable energy (ME)/kg body weight (BW)0.6/day. Total feces and urine were collected for the determination of digestible energy (DE) and ME and daily total HP was measured from day 16 to day 20 and fasted on day 21 for the measurement of fasting heat production (FHP). The NE contents of extruded DFRB from different provinces were within the range of values (8.24 to 10.22 MJ/kg DM). There is a discrepancy of approximately 10.01% in the NE content between the DFRB origins. The NE contents of extruded DFRB and pelleted DFRB from the same province were 8.24 vs. 6.56 MJ/kg DM. Retained energy (RE) and FHP of diets containing extruded DFRB and pelleted DFRB were 1105 vs. 892 kJ/kg BW0.6/day and 746 vs. 726 kJ/kg BW0.6/day respectively, and those in extruded DFRB from different origins were within the range of values (947 to 1105 kJ/kg BW0.6/day and 726 to 755 kJ/kg BW0.6/day, respectively). In conclusion, NE values are affected by origin and processing technology of DFRB.

Updating analysis of nitrogen balance experiments in dairy cows

Nitrogen balance (NB) experiments allow calculation of N retention in the body by subtracting N excreted in feces (NF), urine (NU) and milk (NM) from N intake (NI). In a previous study, we found that NB data from experiments with lactating dairy cows were generally high and, in the current meta-analysis, we update our earlier study with experiments from the last 2 decades and investigate probable causes of error. A total of 83 publications, with 86 experiments and 307 dietary treatments, were selected from top-ranked scientific journals that reported all NB components. The NB and NB components were analyzed by linear regression with a model that used NI as an independent variable and experiment as a random effect. The NF, NU and NM each represented 27 to 34% of NI, and the remaining N accumulated in the body was equal to 38.5 g/d (overall SD = 43.2 g/d). Retained N (as g/d or % of NI) increased linearly with NI, and this led to unlikely high N retentions, especially at high NI. Both NF and NU (g/d) increased with increasing NI, and we assume that some N in feces and urine were unaccounted. Only ~22% of experiments measured N in wet feces samples and, when analysis used dry samples, no mention of corrections due to potential volatile N losses during drying were reported. No experimentalists preserved feces immediately to prevent volatilization during collection. Moreover, ~27% of experiments estimated urine volumes by concentration of creatinine in spot samples, and in these experiments, NU was ~12% lower than those where total urine was collected (168 vs. 191 g/d). Only 40 experiments reported the volume and concentration of acids used for urine preservation, 33 furnished incomplete information, and the remainder did not describe the urine preservation method. In conclusion, the results of NB experiments using lactating dairy cows overestimate N retention, and the losses of N from feces and urine are the most probable reason.

Ameliorative effect of apelin-13 against renal complications in L-NAME-induced preeclampsia in rats.

Pre-eclampsia (PE) accompanying acute liver and kidney injury has remained a master cause of both fetal and maternal mortality and morbidity. Vasoactive mediators, oxidative stress and inflammatory imbalanceshave an important role in PE pathogenesis. Apelin is an adipokine that improves endothelial dysfunction; has anti-inflammatory and antioxidant effects; moreover, its level reduced during PE. This study aimed to explore the effects of apelin-13 administration on preeclampsia-associated renal dysfunction and proteinuria. Thirty-three pregnant female rats were divided into three groups; group: 1 (normal pregnant rats), group: 2 (preeclamptic rats); where rats were injected subcutaneously with 75 mg L-NAME/ kg body weight/day beginning from 9th to 20th day of pregnancy andgroup 3 (apelin-13 treated preeclamptic rats); In which L-NAME-induced preeclamptic rats were subcutaneously injected with 6 × 10−8 mol apelin-13/kg body weight/twice daily starting from 6th to 20th day of pregnancy. In all groups, mean arterial blood pressure, total urine protein, serum urea, creatinine, nitric oxide (NO), endothelin-1 (ET-1), interleukin–6 (IL-6) and malondialdhyde (MDA) were measured. Histopathological examination of kidney tissues was also done. preeclamptic rats showed significantly increased mean arterial blood pressure, total urine proteins, serum urea, creatinine, ET-1, IL-6, and MDA, but revealed a significantly decreased serum NO level. On the other hand, apelin treatment significantly improved these parameters together with amelioration of kidney histoarchitecture in the treated group. In conclusion, apelin may be a potentially curative candidate for prohibiting kidney damage and have a therapeutic benefit in PE rat models.

Клінічний випадок гестаційного нецукрового діабету

Нецукровий діабет належить до рідкісних ендокринологічних захворювань і трапляється в 2–4 пацієнток на 100000 вагітностей. Діагностика гестаційного нецукрового діабету доволі складна, оскільки він розвивається на тлі фізіологічних процесів, які супроводжують вагітність: поріг спраги знижується, що призводить до полідипсії, зменшується й осмолярність плазми, спричиняючи гіпотонічну поліурію. Розуміння патологічної фізіології захворювання дуже важливе для подальшого ведення цих пацієнток. Наводиться опис клінічного випадку. 32-річна жінка на 36-му тижні гестації, перша вагітність, була направлена на консультацію до ендокринолога зі скаргами на поліурію (6,5л/добу), ніктурію — до 5 разів, виражену полідипсію. На 12-му тижні існував ризик переривання вагітності, з приводу чого пацієнтка отримувала 100 мг прогестерону інтравагінально до 34 тижнів. В анамнезі підгострий тиреоїдит. Сімейний анамнез з боку ендокринної патології не обтяжений. Під час фізикального обстеження виявлені зниження тургору шкіри, артеріальний тиск 110/85 мм рт.ст., частота серцевих скорочень 115 уд/хв, маса тіла 71 кг (індекс маси тіла 26,9кг/м2). Пацієнтка перебувала в групі високого ризику розвитку прееклампсії. Лабораторні дані: аналіз сечі за Зимницьким: обсяг на добу — 6,8 л, питома вага в порціях: 1,012; 1,008; 1,010; 1,005; 1,012; 1,014; 1,010. Загальний аналіз крові, загальний аналіз сечі, вміст натрію та калію в сироватці крові, функції печінки, рівень тиреотропного гормону, вільного тироксину, антитіл до тиреоїдної пероксидази та вільного кортизолу вранці— без патологічних змін. Пацієнтці призначили десмопресин по 10 мкг інтраназально двічі на день. Через 6 тижнів після пологів прийом десмопресину було припинено, подальших ознак поліурії, полідипсії або ніктурії не відзначалося.

Estimating purine derivatives and nitrogen compound excretion using total urine collection or spot urine samples in grazing heifers.

The study aimed to evaluate the excretion of purine derivatives (PDs) and nitrogen compounds (NCs) and their ratios with creatinine in supplemented Zebu heifers kept on pastures by comparing total urine collection and spot sampling. Five Nelore heifers (400±15kg) were used in a 5×5 Latin square design. The treatments were the amount of concentrate (220g of crude protein/kg dry matter) offered (0, 3, 6, 9 and 12g/kg BW). In each period, the total urine collection was performed continuously for 3days (subsampled at intervals of 4h, 00:00-04:00h, 04:00-08:00h, 08:00-12:00h, 12:00-16:00h, 16:00-20:00h and 20:00-24:00h). The spot urine samplings were performed (in each period) for 24h (0, 4, 8, 12, 16 and 20h). Creatinine, total urinary nitrogen (UN), urea nitrogen (UreaN), allantoin and uric acid were analysed. Creatinine excretion was 23.01±0.19mg/kg BW and was not affected by collection day, treatment or their interactions (p>0.05). Treatments affected (p<0.05) PD excretions, however did not affect the ratio PD:creatinine (p>0.05). Treatments and collection time affected (p<0.05) NC excretion, whereas the UN:creatinine and UreaN:creatinine ratios were not affected (p>0.05). Creatinine excretion and the PD:creatinine ratios in the urine samples estimated by the total or spot sampling were not different (p>0.05). However, sampling method affected (p<0.05) the UN:creatinine and UreaN:creatinine (p<0.05) ratios. Creatinine can adequately estimate urinary excretion in grazing heifers, and a single spot urine sample at any time of the day can be used to estimate PD excretion in grazing heifers. But two spot urine samples are needed for proper NC excretion estimations in grazing heifers' urine.

Nitrogen balance and blood urea nitrogen by gestating sheep offered alfalfa silage wrapped with or without an enhanced oxygen barrier plastic after time delays up to three days

Exposing ensiling forage to oxygen can result in dry matter deterioration and reduce silage intake by animals. This study was conducted to investigate the effects of two different wrapping sources and time intervals between baling and wrapping on N utilization in gestating sheep offered alfalfa silage. Alfalfa silage was baled in large round bales (moisture concentration = 591 ± 43.0 g/kg), then wrapped with plastic using either an enhanced oxygen-limiting barrier (EOB) or no additional barrier (conventional wrap; CW) on the day of baling or 1, 2 or 3 d after baling. After 5 months of storage, silages were chopped, then offered randomly for ad libitum consumption to 16 gestating ewes [63.5 ± 1.71 kg body weight] to provide 2 observations per treatment for each of 3 experimental total collection periods. Each study period consisted of a 10-d dietary adaptation period followed by 7 d of total fecal and urine collection. Blood was collected immediately prior to feeding and four hours after feeding on the last day of each period. Data were analyzed using PROC MIXED of SAS for a 2 × 4 factorial treatment arrangement, while blood data were treated as repeated measures. When expressed as a portion of total N, neutral detergent insoluble N (NDIN) content of silage increased (P ≤ 0.02) linearly and quadratically, and acid detergent insoluble N (ADIN) concentrations increased (P < 0.01) linearly with longer wrapping delays. Nitrogen apparent absorption (g/d and g/kg N intake) and urinary N (g/d) decreased (P ≤ 0.04) linearly with extended time delays between baling and wrapping. Retained N (g/kg of N intake and of absorbed N) was greater (P = 0.04) from silage wrapped with EOB. Blood urea N concentrations (mg/dL) decreased (P = 0.02) quadratically with extended delay between baling and wrapping. Digestion of NDIN (g/kg NDIN intake) increased (P = 0.03) linearly with extending time delay when silage was wrapped with EOB and linearly and quadratically (P < 0.01) when wrapped with CW. Digestion of ADIN increased (P = 0.02) quadratically with increasing delay between baling and wrapping averaged across wrap types. Therefore, management practices to limit oxygen exposure during packaging and ensiling can prevent a decline in N utilization by ruminants.

The furosemide stress test, electrolyte response and Renal Index in critically ill patients.

Acute kidney injury (AKI) is a common syndrome in critically ill patients. The diagnostic ability of traditional markers such as serum creatinine has recently been questioned, and the use of newer tests such as the furosemide stress test or the ultrasound assessment of renal resistive index have been proposed. Aim of the present study was to compare the response to a furosemide stress test, the Renal Index in mechanically ventilated patients with and without acute kidney injury at admission, and who did or did not develop AKI at day three, among those with normal renal function at the CIU admission. Prospective observational study in consecutive mechanically ventilated patients admitted in a general intensive care. Furosemide stress test and ultrasonographical Renal Index were performed at the admission and clinical and laboratory data were collected before and two hours after the furosemide stress text. The urine output after the first and the second hours was recorded. Forty patients were enrolled, 19 of whom had AKI at admission. The Renal Index was significantly higher in patients with AKI (0.77±0.07 vs. 0.72±0.08, P=0.027); patients with AKI had a significantly lower urine output after the furosemide stress test (400 [340; 1400] vs.1525 [400; 2550] mL; P=0.013). The plasma concentrations of sodium, potassium and chloride were not different before and after the furosemide stress test in patients with and without AKI, whereas in patients with AKI, the total urine output of sodium, potassium and chloride were significantly lower compared to patients without AKI. Similar results were found in patients without AKI at admission and who developed AKI at day three as compared to those who did not develop AKI. The response to the furosemide stress test and the Renal Index could be used as additional tools to evaluate the kidney function in critically ill patients.

Water intake and progression of chronic kidney disease: the CKD-REIN cohort study.

Optimal daily water intake to prevent chronic kidney disease (CKD) progression is unknown. Taking the kidney's urine-concentrating ability into account, we studied the relation of kidney outcomes in patients with CKD to total and plain water intake and urine volume. Including 1265 CKD patients [median age 69 years; mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from the Chronic Kidney Disease-Renal Epidemiology and Information Network cohort (2013-19), we assessed fluid intake at baseline interviews, collected 24-h urine volumes and estimated urine osmolarity (eUosm). Using Cox and then linear mixed models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney failure and eGFR decline associated with hydration markers, adjusting for CKD progression risk factors and eUosm. Patients' median daily intake was 2.0 L [interquartile range (IQR) 1.6-2.6] for total water and 1.5 L (1-1.7) for plain water, median urine volume was 1.9 L/24 h (IQR 1.6-2.4) and mean eUosm was 374 ± 104 mosm/L. Neither total water intake nor urine volume was associated with either kidney outcome. Kidney failure risk increased significantly with decreasing eUosm ˂292 mosm/L. Adjusted HRs (95% CIs) for kidney failure associated with plain water intake were 1.88 (1.02-3.47), 1.59 (1.06-2.38), 1.76 (0.95-3.24) and 1.55 (1.03-2.32) in patients drinking <0.5, 0.5-1.0, 1.5-2.0 and >2.0 L/day compared with those drinking 1.0-1.5 L/day. High plain water intake was also significantly associated with faster eGFR decline. In patients with CKD, the relation between plain water intake and progression to kidney failure appears to be U-shaped. Both low and high intake may not be beneficial in CKD.

A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout

The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design.

ATP shows more potential as a urinary biomarker than acetylcholine and PGE2, but its concentration in urine is not a simple function of dilution

To determine whether the amount of ATP, prostaglandin E2 (PGE2 ), and acetylcholine (ACh) in voided urine are influenced enough by that released within the lower urinary tract (LUT) for them to be useful biomarkers of bladder function. Participants without LUT symptoms collected total urine voids at 15, 30, 60, and 120 min (20 males/23 females) and 240 min (18 males/26 females) following the previous void. Aliquots of urine were immediately frozen at -20°C and later used to measure ATP (luciferin-luciferase), PGE2 (enzyme-linked immunosorbent assay), ACh (mass spectrometry), creatinine (colorimetric), and lactose dehydrogenase (colorimetric). The amount of ATP in voided urine correlated strongly with the rate of urine production, suggesting that the majority, if not all, the ATP in voided urine has an LUT, and likely bladder, origin. In contrast, there appeared to be no significant net LUTs release of creatinine or ACh into the urine. PGE2 was intermediate with an LUT component that increased with urine production rate and contributed about 25% of the total at 1 ml/min in women but a smaller fraction in men. Whereas the majority of the ATP measured within the voided urine originates in the LUT, ACh reflects that extracted from the plasma in the kidneys and PGE2 is a mixture of both sources. ATP has the most potential as a biomarker of benign bladder disorders. Expressing urinary ATP concentration relative to creatinine concentration is questioned in light of these results.

Association between body mass index and arsenic methylation in three studies of Bangladeshi adults and adolescents

BackgroundWater-borne arsenic (As) exposure is a global health problem. Once ingested, inorganic As (iAs) is methylated to mono-methyl (MMA) and dimethyl (DMA) arsenicals via one-carbon metabolism (OCM). People with higher relative percentage of MMA (MMA%) in urine (inefficient As methylation), have been shown to have a higher risk of cardiovascular disease and several cancers but appear to have a lower risk of diabetes and obesity in populations from the US, Mexico, and Taiwan. It is unknown if this opposite pattern with obesity is present in Bangladesh, a country with lower adiposity and higher As exposure in drinking water. ObjectiveTo characterize the association between body mass index (BMI) and As methylation in Bangladeshi adults and adolescents participating in the Folic Acid and Creatine Trial (FACT); Folate and Oxidative Stress (FOX) study; and Metals, Arsenic, and Nutrition in Adolescents Study (MANAS). MethodsArsenic species (iAs, MMA, DMA) were measured in urine and blood. Height and weight were measured to calculate BMI. The associations between concurrent BMI with urine and blood As species were analyzed using linear regression models, adjusting for nutrients involved in OCM such as choline. In FACT, we also evaluated the prospective association between weight change and As species. ResultsMean BMIs were 19.2/20.4, 19.8/21.0, and 17.7/18.7 kg/m2 in males/females in FACT, FOX, and MANAS, respectively. BMI was associated with As species in female but not in male participants. In females, after adjustment for total urine As, age, and plasma folate, the adjusted mean differences (95% confidence) in urinary MMA% and DMA% for a 5 kg/m2 difference in BMI were −1.21 (−1.96, −0.45) and 2.47 (1.13, 3.81), respectively in FACT, −0.66 (−1.56, 0.25) and 1.43 (−0.23, 3.09) in FOX, and −0.59 (−1.19, 0.02) and 1.58 (−0.15, 3.30) in MANAS. The associations were attenuated after adjustment for choline. Similar associations were observed with blood As species. In FACT, a 1-kg of weight increase over 2 to 10 (mean 5.4) years in males/females was prospectively associated with mean DMA% that was 0.16%/0.19% higher. DiscussionBMI was negatively associated with MMA% and positively associated with %DMA in females but not males in Bangladesh; associations were attenuated after plasma choline adjustment. These findings may be related to the role of body fat on estrogen levels that can influence one-carbon metabolism, e.g. by increasing choline synthesis. Research is needed to determine whether the associations between BMI and As species are causal and their influence on As-related health outcomes.

Clinical effectiveness and adverse events associated with tolvaptan in patients above 90years of age with acute decompensated heart failure.

With the aging society, the number of very-elderly (VE) patients with acute decompensated heart failure (ADHF) is increasing. Although tolvaptan is recommended for patients with ADHF in whom conventional diuretic therapy is ineffective, few reports exist on VE patients over 90years of age. Therefore, we aimed to evaluate the clinical effectiveness and adverse events associated with tolvaptan in VE patients with ADHF. From January 2011 to December 2018, we retrospectively studied 180 patients with ADHF who were first administered tolvaptan during hospitalization. Patients were divided into two groups, namely, VE patients who were ≥ 90years of age (n = 32) and not-VE patients (NVE) who were < 90years of age (n = 148). The primary effective endpoints were the total urine volume and change in body weight. The safety endpoints evaluated were the incidence of hypernatremia (≥ 150mEq/L) and worsening renal function (WRF) at any time during hospitalization. The median [interquartile range] patient age was 93 [91-94] years in the VE group and 80 [69-85] years in the NVE group. The mean dose of tolvaptan for the first week of administration was similar between groups (7.9 ± 5.0mg, VE group; 7.3 ± 3.7mg, NVE group; p = 0.52). There were no significant differences between the two groups in the total urine volume at 24h (1901 ± 666mL, VE group; 2101 ± 1167mL, NVE group; p = 0.33) and that at 48h (3707 ± 1274mL, VE group; 4195 ± 1990mL, NVE group; p = 0.19) and in the mean change in body weight (-2.5 ± 2.0kg, VE group; -2.7 ± 2.4kg, NVE group; p = 0.70). The median duration of hospitalization was 24 [20-9] and 31 [20-42] days in the VE and NVE groups, respectively (p = 0.67). The incidence of hypernatremia (6.3% (2/32), VE group; 3.4% (5/148), NVE group; p = 0.61) and WRF (25.0% (8/32) VE group; 19.6% (29/148), NVE group; p = 0.31) was similar between the groups. In conclusion, tolvaptan has similar clinical effectiveness in increasing urine volume and decreasing body weight, without increased adverse events, in VE patients with ADHF who were ≥ 90years of age compared to NVE patients with ADHF.