Treatment of congenital nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride in an adult patient

AIM: The effects of treatment with hydrochlorothiazide (HCTZ) combined with amiloride were elucidated and compared to HCTZ treatment alone and combined with acemetacin or triamterene in a Japanese adult patient with congenital nephrogenic diabetes insipidus. METHODS: The study was divided into seven periods: (1) HCTZ and acemetacin; (2) control period; (3) HCTZ; (4) a second control period; (5) HCTZ and amiloride; (6) a third control period, and (7) HCTZ and triamterene. Fluid intake, urine volume, urinary Na, K, creatinine, and osmolality and serum Na, K, Cl, CO2, and osmolality were measured, and free water clearance and proximal and distal tubular Na reabsorption rates were calculated. RESULTS: Without drug administration, the urine volume was about 8,000 ml/day. The urine volume was reduced to about 6,000 ml/day with HCTZ. A further urine volume reduction to about 5,000 ml/day was obtained with the second drug administration, and the effects were similar among the three regimens. Serum and urinary osmolality and free water clearance were also similar among the three combinations, whereas the urinary potassium excretion was the least, and the serum potassium concentration was the highest with HCTZ plus amiloride. Besides, no alkalosis was observed only with this combination. CONCLUSION: HCTZ plus amiloride may be superior to HCTZ plus acemetacin and HCTZ plus triamterene in preventing hyperkaliuria, hypokalemia, and metabolic alkalosis.     

Rapid detection and prevalence of cholesteryl ester transfer protein deficiency caused by an intron 14 splicing defect in hyperalphalipoproteinemia

A deficiency of plasma cholesteryl ester transfer protein (CETP) is one of the genetic causes of increased serum high density lipoprotein (HDL)-cholesterol levels (hyperalphalipoproteinemia). A splicing defect (GA mutation) at the +1 position of intron 14 of the human CETP gene is a common mutation in the Japanese CETP deficiency. A rapid screening method for the splicing defect by means of primer-specified restriction map modification was described. The frequency of the mutation in hyperalphalipoproteinemia was determined, and its frequency in the general population was estimated. During polymerase chain reaction (PCR) with a modified primer, a novel NdeI restiction endonuclease site was created from the mutated allele in the PCR products, which could be visualized after electrophoresis of the digested products. As a result, 21 of 121 unrelated hyperalphalipoproteinemic subjects with HDL-cholesterol 60 mg/dl (1.55 mmol/1), were found to havethe GA mutation. Of the 21 individuals, 8 were found to be homozygous for the mutation. Allele frequency of the mutation was 1.5% (1/68), 2.8% (2/72), 7.1% (4/56), and 47.8% (22/46) in the groups with HDL-cholesterol levels of 60–79 mg/dl, 80–99 mg/dl, 100–119 mg/dl, and 120 mg/dl, respectively. Based on the percentage of the area under the computed normal distribution curve of serum HDL-cholesterol, the frequency of the mutated allele in the general population was estimated to be 0.81 % from the present results. This rapid detection method facilitates large-scale screening of CETP deficiency caused by the splicing defect. The mutation was frequent in Japanese subjects with hyperalphalipoproteinemia, especially in the group with HDL-cholesterol 120 mg/dl.     

A possible translational control of 3-hydroxy-3-methylglutaryl coenzyme A reductase induction by ML-236B(Compactin) in isolated rat hepatocytes

ML-236B (“Compactin”), a competitive inhibitor of 3-hydroxy-3-methylglutaryl(HMG)-CoA reductase, increased the cholesterol synthesis and the HMG-CoA reductase activity in isolated rat hepatocytes. These increases were prevented by 0.2 mM puromycin, but not by 10 μg/ml actinomycin D and 40 μg/ml α-amanitin. These results indicated that the increases in cholesterol synthesis and HMG-CoA reductase activity by ML-236B required the enzyme synthesis but not newly synthesized mRNA. The regulatory site of feed-back inhibition by cholesterol for the HMG-CoA reductase synthesis in liver may be at the translational level.     

A unique affinity and adaptation of renomedullary interstitial cells for hypertonic medium

Collagenase-dispersed cells of renal papillary tissue from adult mongrel dogs were directly inoculated in a modified M.E.M. (Eagle's) giving an osmolality of approximately 1,000 mOsm/L by addition of urea and sodium chloride, and were cultured in an atomosphere of 95%air-5%CO₂ at 37° C.Within twelve hours after inoculation, spindle-shaped cells attached firmly to the surface of culture dishes, while the other cellular components of the inner medulla remained floating in the medium. After several days in culture, the colonies grew to form a confluent cell layer, which was composed of almost homogenous cells giving spindle-shape. These cells kept on the major characteristics of renomedullary interstitial cell(RIC) in morphology as well as in function to produce prostaglandin E.These results appear to be principally attributable to the unique characteristics of RIC, one of which is affinity for high osmolality and the other is different behavior in attachment to the dish.As the procedure proposed here was relatively simple and did not require a long period up to the developement of monolayer, it would provide a promising model “in vitro” to study the humoral regulation of prostaglandin production.