The postobstructive kidney. Observations on nephron function after the relief of 24 hr of ureteral ligation in the dog

Bercovitch, D. Danny; Kasen, L; Blann, Laurence; Levitt, Marvin F.

doi:10.1172/jci106588

Cited by 20 publications

(7 citation statements)

References 24 publications

(27 reference statements)

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“…Glomerular filtration rate (GFR), urinary output and sodium excretion dropped to 9, 28 and 23% of controls, respectively, i.e., the excreted fraction of filtered water and sodium rose significantly. Similar findings have been published by others [6,28].…”

Section: Introductionsupporting

confidence: 93%

Effect of Indomethacin on Renal Function Before and After Release of 24 Hours Unilateral Ureteral Ligation

László¹,

Juszkó²,

Bálint³

1979

Kidney Blood Press Res

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In the anaesthetized dog during and 1 h after release of 24 h unilateral ureteral ligation (UUL) renal blood flow (RBF) decreased to 48 and 43%, respectively, as compared with normal controls. Radioactive microspheres revealed an inward distribution of RBF inasmuch as the ratio outer/inner cortical perfusion (OC/IC) dropped from a control value of 79/21 to 57/43 and 50/50 before and after release, respectively. In normal dogs inhibition of prostaglandin production by indomethacin caused a decrease of RBF with outward distribution, OC/IC amounting to 85/15. Indomethacin treatment in dogs with 24 h UUL led to a further 50% decrease in RBF with a nearly proportional reduction in outer and inner cortical perfusion, with OC/IC ratios amounting to 79/21 before and 74/26 after release. It is assumed that in the ligated kidney prostaglandins produced in the medulla are not transported by the tubular fluid to the outer cortical zones and only exert their dilating effect on the inner cortical, i.e., juxtamedullary, vessels.

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Section: Introductionsupporting

confidence: 93%

Effect of Indomethacin on Renal Function Before and After Release of 24 Hours Unilateral Ureteral Ligation

László¹,

Juszkó²,

Bálint³

1979

Kidney Blood Press Res

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“…This, however, did not occur, for, during hypotonic saline diuresis in the exper imental kidney free water clearance was only 6.1 ml/min/100 ml Ccr at frac tional urine flow of 11.5 ml/100 ml Ccr, as compared with mean C h ,o of 7.0 + 1.1 (SD) ml/min/100 ml GFR observed at comparable rates of urinary flow in four volunteers under similar experimental conditions reported from this laboratory [13], The role of reduced permeability of the collecting duct to water in diminishing back-diffusion of water was probably of minor import ance in view of the ability to reabsorb free water by the experimental kidney during hydropenia. Reduced medullary hypertonicity in our patient also probably cannot account for the enhanced fractional excretion of salt in the experimental kidney, for no tendency for renal salt wasting was observed in rats with congenital diabetes insipidus in which medullary hypertonicity was obliterated [23], Increased intratubular fluid flow ('overperfusion') of the distal nephron independent of systemic factors has previously been described in dogs, follow ing the relief of chronic ureteral occlusion by S uki et al [19], and Berkovitch et al [20], Greatly enhanced free water clearance relative to GFR suggesting distal nephron overperfusion in man was described by Better etal. [21] follow ing relief of complete unilateral obstruction of 3 months' duration.…”

Section: Discussionsupporting

confidence: 46%

“…Evidence for increased GFR/nephron is not, however, found in all or most examples of postobstructive uropathy. Berkovitch et al [20] even felt that glomerular perfusion may be reduced on the basis of the diminution of the ratio of GFR/ Tm glucose in their dogs following 24-hour ureteral occlusion. In the present patient the difference between control and experimental ratio of GFR/Tm glucose was probably too small to allow any definite conclusion to be made on that basis.…”

Section: Discussionmentioning

confidence: 98%

Intrarenal Resetting of Glomerulotubular Balance in a Patient with Postobstructive Uropathy

Better¹,

Tuma²,

Richter-Levin³

et al. 1972

Nephron

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Complete bilateral malignant ureteral occlusion was relieved by introduction of a nephrostomy tube, first into the right kidney and 3 weeks later into the left kidney. When the second nephrostomy tube was introduced, the right kidney had recovered sufficiently to eliminate the uremic environment and to serve as control organ. This offered the rare opportunity to study in man the function of the kidney following chronic obstruction, independent of systemic influences on tubular function, such as uremia, secondary hyperparathyroidism and the state of hydration of the patient. In the left (‘experimental’) kidney glomerular filtration (GFR) was markedly reduced and fractional and, on occasions, absolute excretion of sodium, calcium and magnesium exceeded simultaneous values in the right (‘control’) kidney. During hypotonic saline and mannitol diuresis, free water clearance relative to GFR and calculated distal delivery of sodium in the experimental kidney exceeded control values by more than twofold and more than threefold, respectively. Distal tubular function, as judged by the ability to generate free water and exchange sodium for potassium, appeared spared. These data suggest that in obstructive uropathy in man there is an intrarenal resetting of the glomerulotubular balance resulting in diminution of proximal tubular reabsorption of sodium, water and probably also divalent cations, which leads to enhanced tubular flow (‘overperfusion’) in the relatively intact distal nephrons. This change in glomerulotubular balance is brought about by an undefined mechanism, initiated by ureteral occlusion or by reduction in nephron population or their combination, and contributes to the profuse natriuresis and diuresis seen following the relief of ureteral occlusion.

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“…Identical findings have been described in patients after relief of urinary obstruction (7,(11)(12)(13)(14). While a number of recent studies have been directed to the renal functional changes associated witlh unilateral obstruction (15,16) and acute (17,18) and chronic (18) elevation of ureteral pressure, data obtained after release of total obstruction have been sparse and related primarily to the defects in sodium and water excretion in this lesion (8). The impairment of glomerular filtration after release of bilateral obstruction has remained unexplored and the present study is directed primarily to determining the pathogenesis of this excretory defect.…”

Section: Methodsmentioning

confidence: 83%

The Renal Functional Defect of Postobstructive Nephropathy

Jaenike¹

1972

J. Clin. Invest.

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A B S T R A C T This study was designed to examine the pathogenesis of the excretory defect produced by bilateral ureteral' obstruction in the rat. After release of obstruction of 24 hr duration glomerular filtration rate was reduced to 20% of normal. Free flow proximal tubular pressure was normal, excluding residual obstruction as a cause of depressed filtration, and indicating that an intrarenal hemodynamic abnormality was primarily responsible for the excretory defect. Total renal blood flow and cortical distribution of flow were normal. Clearance and micropuncture studies indicated the presence of marked heterogeneity of nephron function with residual excretory function residing primarily in vasodilated nephrons in which decreased postglomerular arteriolar resistance effected a reduction in glomerular filtration pressure. Heterogeneity of nephron function was evidenced by a wide scatter of values for single nephron filtration rate and from direct intratubular injection of dye which revealed that at least 28% of surface nephrons were either nonfiltering or had filtration rates too-low to measure. The observed decrease in Hippuran extraction and increased ratio of Hippuran to inulin clearance ratio is characteristic of the vasodilated kidney. Further evidence of the vasodilated nature of residual functioning nephrons was demonstrated by the failure of intrarenal papaverine infusion to increase filtration rate in this lesion.The hemodynamic defect produced by bilateral obstruction is contrasted with that seen after release of unilateral ureteral ligation in which depression of filtration rate appears to result primarily from preglomerular vasoconstriction. This difference raises the possibility that a vasodilating substance accumulates during total suppression of renal excretory function.

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The postobstructive kidney. Observations on nephron function after the relief of 24 hr of ureteral ligation in the dog

Cited by 20 publications

References 24 publications

Effect of Indomethacin on Renal Function Before and After Release of 24 Hours Unilateral Ureteral Ligation

Effect of Indomethacin on Renal Function Before and After Release of 24 Hours Unilateral Ureteral Ligation

Intrarenal Resetting of Glomerulotubular Balance in a Patient with Postobstructive Uropathy

The Renal Functional Defect of Postobstructive Nephropathy

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