The Response of Arginine Vasopressin to Intravenous Ethanol and Hypertonic Saline in Man: The Impact of Aging

Helderman, J. Harold; Vestal, Robert E.; Rowe, John W.; Tobin, Jordan D.; Andres, Reubin; Robertson, Gary

doi:10.1093/geronj/33.1.39

Cited by 285 publications

(90 citation statements)

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“…The influence of age on AVP secretion may also be involved in the development of hyponatremia because AVP release is greater in the elderly subjects than in the young. This was also described by other investigators [17,18]. We can mention that the reduced renal concentrating ability also contributes to the enhancement of AVP secretion from the neurohypophysis in the elderly subjects.…”

Section: Discussionsupporting

confidence: 82%

Involvement of Arginine Vasopressin and Renal Sodium Handling in Pathogenesis of Hyponatremia in Elderly Patients.

Ishikawa¹,

Fujita²,

Fujisawa³

et al. 1996

Endocr J

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Abstract. The present study was undertaken to determine the pathophysiological role of arginine vasopressin (AVP) in elderly patients with hyponatremia, and the efficacy of fludrocortisone acetate in treating their hyponatremia. Eleven hospitalized patients aged 65 years or older whose serum sodium levels were less than 130 mEq/l were examined. The hyponatremic patients included two groups of patients: syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and central salt-wasting syndrome. And 24 healthy, young subjects aged 20 to 34 years, and 24 healthy, elderly subjects aged 65 to 80 years were recruited by community announcement. The elderly subjects had decreased urinary concentrating ability and exaggerated response of AVP secretion to osmotic and nonosmotic stimuli, as compared to the young subjects. All the patients had hyponatremia, with the exaggerated urinary loss of Na. Plasma AVP levels were elevated despite hypoosmolality in all the 2 groups of hyponatremic, elderly patients. Plasma renin activity and plasma aldosterone concentrations were low in the patients with SIADH and central salt-wasting syndrome. Fludrocortisone acetate therapy was effective in the patients with central salt-wasting syndrome and 3 patients with SIADH whose hyponatremia remained unchanged after water restriction. Water restriction therapy normalized serum Na levels in only 3 patients with SIADH. These results indicate that AVP is involved in the mechanism for hyponatremia in the elderly patients with SIADH and central salt-wasting syndrome. Severe hyponatremia associated with SIADH and central salt-wasting syndrome responds well to mineralocorticoid therapy. Both the secretion of AVP and renal sodium handling may be involved in the mechanisms of action of the disorders. The diagnostic criteria for SIADH in the elderly patients may have to be reevaluated and should be considered to indicate fludrocortisone acetate therapy.

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Section: Discussionsupporting

confidence: 82%

Involvement of Arginine Vasopressin and Renal Sodium Handling in Pathogenesis of Hyponatremia in Elderly Patients.

Ishikawa¹,

Fujita²,

Fujisawa³

et al. 1996

Endocr J

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“…In this regard, our previous study found that there is significantly more augmentation in AVP release in response to the osmotic and non-osmotic stimuli in elderly subjects than in young subjects (15). Similarly, such a gerontological alteration in the release of AVP was also reported by other investigators (13,14,16). Thus, aging per se enhances the physiological release Relationship between serum Na levels and age in patients with secondary adrenal insufficiency.…”

Section: Discussionsupporting

confidence: 55%

Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency

et al. 2003

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Objective: Hyponatremia occurs not infrequently in hypopituitarism. Arginine vasopressin (AVP)-induced impaired water excretion is found in patients with hypopituitarism and experimental models of glucocorticoid deficiency. Design: The present study was undertaken to determine whether augmented release of AVP is involved in the development of hyponatremia in elderly subjects with secondary adrenal insufficiency. Methods: Forty patients with ACTH-deficient, secondary adrenal insufficiency were examined. They were divided into three groups according to the age at which diagnosis was ascertained (group A , 20 years, group B 20-64 years, and group C $ 65 years). Results: Hyponatremia was more manifest in the elderly group than in the other two groups, serum sodium (Na) levels being 124.7 mmol/l in the elderly group, a value significantly less than 141.5 and 133.5 mmol/l in groups A and B. Plasma AVP levels seemed likely to be high compared with the respective hypo-osmolality in plasma in the elderly group, as plasma AVP levels were 1.7 pmol/l despite a mean plasma osmolality of 259 mmol/kg. Such an alteration was less clear in group B and was not found in group A. Therefore, elevation of plasma AVP was apparent in the elderly patients. Hydrocortisone replacement promptly normalized serum Na levels from 125 to 142 mmol/l ðP , 0:01Þ and reduced plasma AVP levels from 1.7 to 0.9 pmol/l ðP , 0:05Þ; which were comparable to the respective plasma osmolality in the elderly patients. Conclusion: These results indicate that non-suppressible release of AVP is crucially involved in the impaired water excretion and hyponatremia seen in elderly patients with secondary adrenal insufficiency compared with the younger patients, and that exaggerated release of AVP becomes manifest as the subjects grow older.

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“…To our knowledge, increased tubular reabsorption in the elderly has not been reported. The association of higher plasma urea levels and lower FE urea values in the elderly could reflect a preservation of the tubular effect of vasopressin on urea reabsorption, which possibly differs from the widely known age-related decrease in water reabsorption in the elderly (19 -21), despite an enhanced osmoreceptor sensitivity to vasopressin release (7,22) and higher vasopressin levels (7,(23)(24)(25). In rats, age-associated defects in urine concentration are accompanied by a downregulation of renal vasopressin V 2 receptors and aquaporin-2 expression (26).…”

Section: Discussionmentioning

confidence: 98%

Age-Related Increase in Plasma Urea Level and Decrease in Fractional Urea Excretion

Musch

Verfaillie

Decaux

2006

Clinical Journal of the American Society of Nephrology

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This study confirms in humans an age-related increase in plasma urea levels (r ‫؍‬ 0.62; P < 0.001; y ‫؍‬ 0.229x ؉ 18.26) and no correlation between plasma creatinine and age (r ‫؍‬ 0.06; NS). Fractional urea excretion (FE urea) decreases with age (r ‫؍‬ ؊0.41; P < 0.001; y ‫؍‬ ؊0.226x ؉ 55). Comparing urea and creatinine clearances, measured in 19 young and in 15 old women, a larger decrease of urea clearance (؊56%) compared with the creatinine clearance (؊43%) was observed as expected, explaining the lower FE urea in the elderly. In old women, the daily urea excretion was 27% and the daily creatinine excretion was 42% lower than in young women. An age-related decrease of same magnitude in both creatinine production and creatinine clearance explains why plasma creatinine remains stable with increasing age. The observation of a more important decrease in urea clearance (56%) than in urea production (27%) in older women led to an expected increase in plasma urea of 29%. These observations incited a comparison of biochemical profiles from younger and older patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Young patients with SIADH present lower mean plasma urea (18 ؎ 8 mg/dl) and higher mean FE urea (58 ؎ 14%), compared with both young control subjects (mean plasma urea 27 ؎ 7 mg/dl; mean FE urea 46 ؎ 10%) and old patients with SIADH (mean plasma urea 29 ؎ 8 mg/dl; mean FE urea 44 ؎ 15%). Physicians must realize that frankly low plasma urea values and high FE urea values can be expected only in young patients with SIADH, whereas old patients with SIADH will present values of plasma urea and FE urea in the same range than young control subjects. However, old patients with SIADH show still lower mean plasma urea values and higher mean FE urea values, compared with old control subjects (mean plasma urea 39 ؎ 8 mg/dl; mean FE urea 36 ؎ 9%), in whom plasma urea values between 40 and 50 mg/dl must be considered as usual.Clin J Am Soc Nephrol 1: 909 -914, 2006. doi: 10.2215/CJN.00320106 B oth plasma urea and fractional urea excretion (FE urea) are considered as useful biochemical parameters in the differential diagnosis of salt-depleted hyponatremic and patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (1-3). Hyponatremia in SIADH is usually associated with a low plasma urea as a result of a high FE urea (4), whereas in hyponatremia that is caused by salt depletion (SD), plasma urea usually is increased as a result of an abnormal low FE urea (5) (prerenal uremia). Unfortunately, the usefulness of plasma urea and FE urea in discriminating SIADH and SD is limited by an important degree of "overlapping" values. In earlier work (6), we noted that plasma urea values Ͼ30 mg/dl were observed in 82% of patients with SD, whereas plasma urea values Ͻ30 mg/dl were seen in 79% of patients with SIADH. Eighty-two percent of the patients with salt-depleted hyponatremic presented FE urea values Ͻ50%, but only 52% of the patients with SIADH showed FE urea values Ͼ50...

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The Response of Arginine Vasopressin to Intravenous Ethanol and Hypertonic Saline in Man: The Impact of Aging

Cited by 285 publications

References 0 publications

Involvement of Arginine Vasopressin and Renal Sodium Handling in Pathogenesis of Hyponatremia in Elderly Patients.

Involvement of Arginine Vasopressin and Renal Sodium Handling in Pathogenesis of Hyponatremia in Elderly Patients.

Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency

Age-Related Increase in Plasma Urea Level and Decrease in Fractional Urea Excretion

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