Mechanism of Effect of Hypoxia on Renal Water Excretion

Anderson, Robert J.; Pluss, Richard G.; Berns, Arnold S.; Jackson, James T.; Arnold, P; Schrier, Robert W.; McDonald, Keith M.

doi:10.1172/jci109188

Cited by 104 publications

(45 citation statements)

References 39 publications

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“…which has been independently shown to induce ADH secretion admission values were all comparable to the bronchiolitis group (25)(26)(27). Finally, stress through central hypothalamic pathways discharge values.…”

Section: A D M I S S I O N D I S C H a R G Ementioning

confidence: 65%

Water, Electrolyte, and Endocrine Homeostasis in Infants with Bronchiolitis

et al. 1990

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ABSTRACT. Twenty-two of 23 consecutive infants with bronchiolitis, 5.5 f 3.5 mo of age, showed a 1.9 f 1.4% increase in body weight, increased urinary osmolality of 737 f 193 mmol/L with low plasma osmolality of 275 f 4 mmol/L, and markedly elevated plasma antidiuretic hormone (ADH) levels of 114 f 225 pg/mL. Increased ADH, which usually suppresses plasma renin activity, was associated with increased plasma renin activity of 11-55 ng angiotensin l/mL/h (normal for age < l o ng angiotensin 1/ mL/h). Hyperaldosteronism was evident from the low fractional excretion of sodium of 0.27 f 0.2% and high fractional excretion of potassium of 21 f 15%. Serum sodium concentrations were normal. All of the pathologic findings returned to normal when the bronchiolitis subsided. A control group of 10 infants with nonrespiratory febrile illness did not show any of the above abnormalities. Thus, bronchiolitis of infancy is characterized by both increased ADH secretion and hyperreninemia with secondary hyperaldosteronism, which induce water retention but counterbalance each other with respect to serum sodium. Increased ADH secretion as well as increased plasma renin activity are not "inappropriate," but rather suggest a response to the perception of hypovolemia by intrathoracic receptors. We therefore conclude that the clinical management of bronchiolitis requires close monitoring of body wt and plasma osmolality-urinary osmolality relationship; serum sodium levels may be misleading. (Pediatr Res 27: 204-209,1990) Abbreviations ADH, antidiuretic hormone SIADH, syndrome of inappropriate ADH secretion PRA, plasma renin activity FE, fractional excretion Uosm, urinary osmolality Posm, plasma osmolality Ang, angiotensin It has been our clinical impression that infants with severe bronchiolitis develop facial puffiness that lessens and disappears as the respiratory distress improves. The possibility that excess fluid retention causes this appearance has been reinforced by the observation that concomittant with the loss of facial puffiness, a reduction in body wt occurs. The association of (SIADH) has

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Section: A D M I S S I O N D I S C H a R G Ementioning

confidence: 65%

Water, Electrolyte, and Endocrine Homeostasis in Infants with Bronchiolitis

et al. 1990

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“…It is likely that baroreceptor-stimulated vasopressin release is responsible for the decreased urine volume with AV (8,9,13,24). Since severe hypoxemia also can stimulate vasopressin secretion (28), vasopressin also may have contributed to the decrease in urine volume of infants in earlier neonatal studies. The lack of decrease in urine volume associated with AV in our study could be explained either by an inability to produce vasopressin or by decreased sensitivity of the distal nephron to vasopressin.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

et al. 1986

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ABSTRACT. Because renal function and electrolyte balance are commonly altered in premature infants, particularly those requiring ventilatory support, we studied the influence of assisted ventilation on renal electrolyte and water excretion in infants with birth weights less than 1501 g during the 2 days after birth. Twenty-two infants receiving assisted ventilation, either as intermittent mandatory ventilation or nasal continuous positive airway pressure, were compared with 21 spontaneously ventilating infants of similar birthweight and gestational age. Mean (and SEM) creatinine clearance was lower ( p < 0.05) in the assisted ventilation group on day 1 (2.9 f 0.4 versus 4.1 f 0.4 ml/min/1.73 m2) and on day 2 (4.1 2 1.0 versus 6.8 + 0.8 ml/min/1.73 mZ, p = 0.05), and there was a correlation between creatinine clearance and mean blood pressure in both groups. Mean urine vasopressin was higher in the assisted ventilation group on the first day (360 f 86 versus 123 ? 30 pg/mg creatinine; p < 0.02) and correlated with higher urine osmolality. There were no differences in urine volume, in osmolar or free water clearances, or in the intake and urine excretion of sodium, potassium, and chloride. Plasma renin activity, urine aldosterone, and urine prostaglandin E2 were similar in both groups on both days. Neither the mode of assisted ventilation nor the cause of respiratory failure appeared to affect these results. (Pediatr Res 20: 447-452, 1986) Abbreviations PEEP. ~ositive end-ex~ired Dressure , -

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“…This antiserum has virtually no cross-reactivity with oxytocin and vasotocin. Its specificity has been detailed elsewhere (16,17). Sensitivity of the assay using this antiserum in our laboratory was usually 0.1 and always 0.2 pg/assay tube, and the 50% displacement was 5 pg/assay tube.…”

Section: Osmolalitymentioning

confidence: 99%

Osmoregulation during Pregnancy in the Rat

Dürr¹,

Stamoutsos²,

Lindheimer³

1981

J. Clin. Invest.

125

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AB S T R A C T Osmoregulation was studied in near term and age-matched Sprague-Dawley rats. Basal plasma osmolality (Posm) and plasma sodium (PNa) were 281+3 mosmol/kg and 134+3 meq/liter, respectively, on the 20th gestational day compared with 292+±3 mosmol/kg and 140+1 meq/liter in virgin animals (P < 0.001), whereas Purea and plasma water content were similar in pregnant and control rats. These differences could not be reproduced in animals receiving progesterone, estrone, or a combination of progesterone and estradiol for 2 wk.Pregnant and control rats were deprived of water for changes (A%) were significantly greater in the gravid animals (P < 0.01). Therefore, Posm was increased without concomitant volume depletion by intraperitoneal hypertonic saline. Again PAVP VS. Posm correlated significantly (r > 0.9; P < 0.001) in each group, and the apparent threshold was 14 mosmol lower in pregnant animals. Diluting ability, tested by oral water loading, was not impaired in the pregnant animals which excreted a 30 ml/kg load as well as controls. Also, chronically hydrated virgin animals whose fluid intake was more than twice that of pregnant rats (for 19 d) did not lower their Posm.In separate studies homozygous Brattleboro rats, which produce no endogenous vasopressin, were also shown to have a decreased Posm (pregnant 292 +4 mosmol/kg; virgin 310+6 mosmol/kg P < 0.001), but unchanged Uosm during pregnancy.Data demonstrate a resetting ofthe osmostat in gravid Sprague-Dawley rats as Posm and the threshold for AVP secretion both decrease significantly during gestation in this species. Studies in homozygous Brattleboro animals with hereditary diabetes insipidus suggest that the osmotic threshold for thirst is reset as well. INTRODUCTION Plasma osmolality decreases during normal human pregnancy to values that range 5-10 mosmol/kg below that of nonpregnant women (1-3). This decrement is apparent by the 6th gestational wk and is sustained until term. If such a reduction in osmolality occurred in a nongravid subject she would cease secreting antidiuretic hormone (ADH)l and enter a state of con-

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Mechanism of Effect of Hypoxia on Renal Water Excretion

Cited by 104 publications

References 39 publications

Water, Electrolyte, and Endocrine Homeostasis in Infants with Bronchiolitis

Water, Electrolyte, and Endocrine Homeostasis in Infants with Bronchiolitis

The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

Osmoregulation during Pregnancy in the Rat

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