A Standardized Test of Renal Concentrating Capacity in Adults with Some Results in Essential Hypertension

Three groups of patients: A with normal glomerular filtration rate, B with moderate and C with advanced renal damage, were dehydrated and fasted for 30 hours. At regular intervals measurements were taken of urine osmolality, urine specific gravity and serum osmolality. The time required to reach maximum urine osmolality varies with the degree of dehydration and inversely with the severity of kidney damage. In patients with normal glomerular filtration rate, maximum urine osmolality is not attained by 30 hours of dehydration. Thus, for shorter periods, all “normal ranges” of concentrating capacity must be related to specific durations of dehydration. Carefully measured urine specific gravities parallel urine osmolalities closely, especially when proteinuria and glucosuria are absent. The measurement of U/P osmolality ratio offers no clinical advantage in the assessment of renal concentration capacity over the measurement of urine osmolality alone. In Group A, hypertensives achieved higher urine concentrations than did the nonhypertensives under identical test conditions. A normal range for renal concentrating capacity has been presented.     

Antidiuretic function in Sheehan's syndrome.

Twenty patients with postpartum hypopituitarism underwent a dehydration test followed by the administration of synthetic arginine-vasopressin (DDAVP; desmopressin). Panhypopituitarism was confirmed by hormonal assays in the basal state and after stimulation with combined luteinising hormone releasing hormone-thyrotrophin releasing hormone-insulin. All the patients were given replacement therapy with hydrocortisone and thyroid hormones. Results were compared with those in 12 normal women. Urinary concentrating ability was diminished in the patients as compared with the controls (maximum urine osmolality 688 (SEM 23) mmol (mosmol)/kg in the patients v 967 (SEM 29) mmol/kg in the controls). Also the change in urine osmolality after administration of desmopressin was greater in the patients (+9.55 (SEM 1.98)% in the patients v 2.49 (SEM 0.96)% in the controls). Partial diabetes insipidus is apparently common in Sheehan''s syndrome. This association should be borne in mind when managing these patients, especially those in acute failure.     

Role of UTB Urea Transporters in the Urine Concentrating Mechanism of the Rat Kidney

A mathematical model of the renal medulla of the rat kidney was used to investigate urine concentrating mechanism function in animals lacking the UTB urea transporter. The UTB transporter is believed to mediate countercurrent urea exchange between descending vasa recta (DVR) and ascending vasa recta (AVR) by facilitating urea transport across DVR endothelia. The model represents the outer medulla (OM) and inner medulla (IM), with the actions of the cortex incorporated via boundary conditions. Blood flow in the model vasculature is divided into plasma and red blood cell compartments. In the base-case model configuration tubular dimensions and transport parameters are based on, or estimated from, experimental measurements or immunohistochemical evidence in wild-type rats. The base-case model configuration generated an osmolality gradient along the cortico-medullary axis that is consistent with measurements from rats in a moderately antidiuretic state. When expression of UTB was eliminated in the model, model results indicated that, relative to wild-type, the OM cortico-medullary osmolality gradient and the net urea flow through the OM were little affected by absence of UTB transporter. However, because urea transfer from AVR to DVR was much reduced, urea trapping by countercurrent exchange was significantly compromised. Consequently, urine urea concentration and osmolality were decreased by 12% and 8.9% from base case, respectively, with most of the reduction attributable to the impaired IM concentrating mechanism. These results indicate that the in vivo urine concentrating defect in knockout mouse, reported by Yang et al. (J Biol Chem 277(12), 10633–10637, 2002), is not attributable to an OM concentrating mechanism defect, but that reduced urea trapping by long vasa recta plays a significant role in compromising the concentrating mechanism of the IM. Moreover, model results are in general agreement with the explanation of knockout renal function proposed by Yang et al.     

Role of renal prostaglandins in the fall in urine osmolality after papillary micropuncture

The effect of micropuncture of the renal papilla through an intact ureter on urinary concentrating ability of rats was examined. Micropuncture of the renal papilla caused a fall in urine osmolality in the punctured kidney from 1718 +/- 106 to 1035 +/- 79 mosmol/kg X H2O. In order to investigate the role of renal prostaglandins in this process, PGE2 excretion was measured and found to increase from 63.4 +/- 14.0 to 205.5 +/- 57.1 pg/min. Urine osmolality and PGE2 excretion from the contralateral kidney were not significantly altered. In animals given meclofenamate (2 mg/kg X hr), renal PGE2 excretion was reduced to 22.3 +/- 5.1 pg/min prior to micropuncture and it remained low at 8.9 +/- 1.8 pg/min after papillary micropuncture. Meclofenamate also blocked the fall in urine osmolality caused by micropuncture of the renal papilla, with urine osmolality averaging 1940 +/- 122 before and 1782 +/- 96 mosmol/kg X H2O after the micropuncture. These results indicated that papillary micropuncture through an intact ureter increased renal PGE2 excretion and that a rise in renal production of PGE2 or some other prostanoid is associated with a fall in urine concentrating ability.     

A mathematical model of the urine concentrating mechanism in the rat renal medulla. I. Formulation and base-case results

A new, region-based mathematical model of the urine concentrating mechanism of the rat renal medulla was used to investigate the significance of transport and structural properties revealed in anatomic studies. The model simulates preferential interactions among tubules and vessels by representing concentric regions that are centered on a vascular bundle in the outer medulla (OM) and on a collecting duct cluster in the inner medulla (IM). Particularly noteworthy features of this model include highly urea-permeable and water-impermeable segments of the long descending limbs and highly urea-permeable ascending thin limbs. Indeed, this is the first detailed mathematical model of the rat urine concentrating mechanism that represents high long-loop urea permeabilities and that produces a substantial axial osmolality gradient in the IM. That axial osmolality gradient is attributable to the increasing urea concentration gradient. The model equations, which are based on conservation of solutes and water and on standard expressions for transmural transport, were solved to steady state. Model simulations predict that the interstitial NaCl and urea concentrations in adjoining regions differ substantially in the OM but not in the IM. In the OM, active NaCl transport from thick ascending limbs, at rates inferred from the physiological literature, resulted in a concentrating effect such that the intratubular fluid osmolality of the collecting duct increases ~2.5 times along the OM. As a result of the separation of urea from NaCl and the subsequent mixing of that urea and NaCl in the interstitium and vasculature of the IM, collecting duct fluid osmolality further increases by a factor of ~1.55 along the IM.     

Urinary concentrating defect in glutathione-depleted rats

The effect of an acute depletion of glutathione by diethyl maleate injection on renal concentrating function was examined in rats. The parameters tested were the concentration and dilution of urine, applying conventional clearance techniques. Tissue osmolality and Na+-K+ ATPase activity were also measured. Diethyl maleate treated rats showed a diminished renal glutathione concentration and an impairment in the glomerular filtration rate and in electrolyte and water excretion. Treated rats also showed a diminished urine-to-plasma osmolality ratio as compared with controls. The studies on free water formation revealed a marked difference between groups; these data were supported with a diminished medullary Na+-K+ ATPase and a diminished corticomedullary osmolality gradient in the treated rats. The studies suggest that one area of target cells of glutathione depletion is that of the ascending limb of Henle's loop.     

Hypercalciuria Relative to Total Solutes in Nephrolithiasis

Urines obtained from normal controls, from patients with calcium-containing renal stones, and from acutely ill patients suffering from various other renal or electrolyte disorders were analysed for Na, K, NH₄, Ca, Mg, inorganic phosphate and sulphate, pH, and osmolality.The stone-formers'' urines were found to be characterized by hypercalciuria relative to Na, K, Mg, SO₄, osmolality, and ionic strength. Hypercalciuria relative to osmolality was a more consistent finding than hypercalciuria relative to Na.These findings are in keeping with the supposition that calcium-containing renal stones occur in urine saturated with calcium salts.     

江豚的小肾结构指数和尿浓缩能力

对江豚的六项小肾结构指数的测定发现,黄海沿岸江豚的小肾结构指数明显高于长江江豚的。提示前者具有较高的尿浓缩能力。对尿的分析所获结论相同,反映出二者对所栖水域的不同渗透浓度的适应。     

Maximum Urine Concentrating Capability in a Mathematical Model of the Inner Medulla of the Rat Kidney

In a mathematical model of the urine concentrating mechanism of the inner medulla of the rat kidney, a nonlinear optimization technique was used to estimate parameter sets that maximize the urine-to-plasma osmolality ratio (U/P) while maintaining the urine flow rate within a plausible physiologic range. The model, which used a central core formulation, represented loops of Henle turning at all levels of the inner medulla and a composite collecting duct (CD). The parameters varied were: water flow and urea concentration in tubular fluid entering the descending thin limbs and the composite CD at the outer-inner medullary boundary; scaling factors for the number of loops of Henle and CDs as a function of medullary depth; location and increase rate of the urea permeability profile along the CD; and a scaling factor for the maximum rate of NaCl transport from the CD. The optimization algorithm sought to maximize a quantity E that equaled U/P minus a penalty function for insufficient urine flow. Maxima of E were sought by changing parameter values in the direction in parameter space in which E increased. The algorithm attained a maximum E that increased urine osmolality and inner medullary concentrating capability by 37.5% and 80.2%, respectively, above base-case values; the corresponding urine flow rate and the concentrations of NaCl and urea were all within or near reported experimental ranges. Our results predict that urine osmolality is particularly sensitive to three parameters: the urea concentration in tubular fluid entering the CD at the outer-inner medullary boundary, the location and increase rate of the urea permeability profile along the CD, and the rate of decrease of the CD population (and thus of CD surface area) along the cortico-medullary axis.     

The theory of urine formation in water diuresis with implications for antidiuresis

We investigate a model of the renal medulla in which active NaCl transport is restricted to the thick ascending limb of Henle's loop. The model contains a vas rectum, a loop of Henle, salt, and water. The model generates interstitial osmolality curves consonant with the known functioning of the kidney in water diuresis. Using data from the white rat and the curves generated by the model, one can predict the permeability of the thin limb of Henle's loop to NaCl and the percentage of total renal blood flow entering the inner medulla. In this model interstitial osmolality at the papilla can be about twice plasma osmolality, so that NaCl transport restricted to the outer medulla can contribute significantly to the work required in producing a hypertonic urine. However, the interstitial osmolality monotonically decreases proceeding from the junction of the outer and inner medulla to the papilla, and the maximum interstitial osmolality in the outer medulla is greater than the maximum interstitial osmolality in the inner medulla. Thus we infer that a source of active transport located in the inner medulla is needed to explain the high osmolalities observed in hydropenia. A sketch of an alternative model, a “lineal multiplication mechanism”, for the renal concentrating process is presented in which active transport in the inner medulla is restricted to active salt transport by the collecting duct. The lineal multiplication mechanism makes no use of counter-current multipliers in the inner medulla. The research of this author was supported in part by NIH Grant AM06864-03 and a Career Scientist Award from the Health Research Council of New York City, Contr. No. 1391. The research of this author was supported in part by the Office of Naval Research, U.S. Navy under Contr. N(onr) 595(17). The research of this author was supported in part by Grant NSF GP-2067 from the National Science Foundation and was performed at the University of Maryland.     

Renal responses to chronic cold exposure

The aim of this study was to assess our hypothesis that the release of antidiuretic hormone (ADH), the renal concentrating response to ADH, or both is decreased by prolonged cold exposure. Six groups (n = 6/group) of rats were used. Three groups were exposed to cold (5 degrees C), whilethe remaining three groups were kept at room temperature (25 degrees C). It was found that urine osmolality decreased significantly and serum osmolality increased significantly during cold exposure. The ratio of water/food intake was not affected by prolonged cold exposure. However, prolonged cold exposure increased the ratio of urine output/food intake in the cold-exposed rats, indicating that more urine flow is required by the cold-exposed rats to excrete the osmotic substance at a given food intake. The difference between water intake and urine output decreased significantly in the cold-exposed rats. Thus, prolonged cold exposure increases water loss from excretion. Renal concentrating responses to 24-h dehydration and Pitressin were decreased significantly in the cold-exposed rats. Plasma ADH levels remained unchanged, but renal ADH receptor (V2 receptor) mRNA was decreased significantly in the cold-exposed rats. The results strongly support the conclusion that cold exposure increases excretive water loss, and this may be due to suppression of renal V2 receptors rather than inhibition of ADH release.     

Osmotic microenvironments within tissue culture well plates are an important cause of variability in plant protoplast cultures

Summary To determine if the medium osmolality of plant protoplast cultures in 24-well tissue culture plates changes sufficiently during the culture period to affect development of the protoplasts the osmolality and the division of the protoplasts was monitored within the plates over a three week period. Large increases in osmolality were measured in cell-free experiments indicating that overall evaporation from the plates was substantial. The amount of evaporation from a given culture well depended on the position of the well within the plate; three microenvironments corresponding to the corner, edge, and middle positions of the plate consistently developed. Water placed in the recessed area between each culture well moderated the desiccation of the medium but did not eliminate the formation of microenvironments. The osmolality of the medium in protoplast cultures was higher than in the cell-free experiments but similar trends in terms of plate position were recorded. After 3 weeks of incubation of plates with water added between the wells, the osmolality of the medium in the protoplast cultures had increased 209 mOsm in the corner wells, had increased 77 mOsm in the edge wells, and had decreased 39 mOsm in the middle wells. As a result, there was a three-fold higher incidence of division of the protoplasts in the middle wells than in the corner wells. The non-uniformity of medium osmolality in protoplast cultures within tissue cultures well plates is important in experimental design, in the reproducibility of procedures between different laboratories, and in the preparation of replenishment medium for protoplast cultures to minimize osmotic shock. This work was supported by the College of Agriculture and Life Sciences and the Graduate School, University of Wisconsin-Madison; by McIntire-Stennis project WIS 3082; and by the USDA-Forest Service, North Central Forest Experiment Station (B. Haissig, Project Leader).     

Role of renal prostaglandins in the fall in urine osmolality after papillary micropuncture

The effect of micropuncture of the renal papilla through an intact ureter on urinary concetrating ability of rats was examined. Micropuncture of the renal papilla caused a fall in urine osmolality in the punctured kidney from 1718 ± 106 to 1035 ± 79 mosmol/kg·H₂O. In order to investigate the role of renal prostaglandins in this process, PGE₂ excretion was measured and found to increase from 63.4 ± 14.0 to 205.5 ± 57.1 pg/min. Urine osmolality and PGE₂ excretion from the contralateral kidney were not significantly altered. In animals given meclofenamate (2 mg/kg·hr), renal PGE₂ excretion was reduced to 22.3 ± 5.1 pg/min prior to micropuncture and it remained low at 8.9 ± 1.8pg/min after papillary micropuncture. Meclofenamate also blocked the fall in urine osmolality caused by micropuncture of the renal papilla, with urine osmolality averaging 1940 ± 122 before and 1782 ± 96 mosmol/kg·H₂O after the micropuncture. These results indicated that papillary micropuncture through an intact ureter increased renal PGE₂ excretion and that a rise in renal production of PGE₂ or some other prostanoid is associated with a fall in urine concentrating ability.     

Defective renal water handling in transgenic mice over-expressing human CD39/NTPDase1

Ectonucleoside triphosphate diphosphohydrolase-1 hydrolyzes extracellular ATP and ADP to AMP. Previously, we showed that CD39 is expressed at several sites within the kidney and thus may impact the availability of type 2 purinergic receptor (P2-R) ligands. Because P2-Rs appear to regulate urinary concentrating ability, we have evaluated renal water handling in transgenic mice (TG) globally overexpressing hCD39. Under basal conditions, TG mice exhibited significantly impaired urinary concentration and decreased protein abundance of AQP2 in the kidney compared with wild-type (WT) mice. Urinary excretion of total nitrates/nitrites was significantly higher in TG mice, but the excretion of AVP or PGE(2) was equivalent to control WT mice. There were no significant differences in electrolyte-free water clearance or fractional excretion of sodium. Under stable hydrated conditions (gelled diet feeding), the differences between the WT and TG mice were negated, but the decrease in urine osmolality persisted. When water deprived, TG mice failed to adequately concentrate urine and exhibited impaired AVP responses. However, the increases in urinary osmolalities in response to subacute dDAVP or chronic AVP treatment were similar in TG and WT mice. These observations suggest that TG mice have impaired urinary concentrating ability despite normal AVP levels. We also note impaired AVP release in response to water deprivation but that TG kidneys are responsive to exogenous dDAVP or AVP. We infer that heightened nucleotide scavenging by increased levels of CD39 altered the release of endogenous AVP in response to dehydration. We propose that ectonucleotidases and modulated purinergic signaling impact urinary concentration and indicate potential utility of targeted therapy for the treatment of water balance disorders.     

COX-2 disruption leads to increased central vasopressin stores and impaired urine concentrating ability in mice

It was hypothesized that cyclooxygenase-2 (COX-2) activity promotes urine concentrating ability through stimulation of vasopressin (AVP) release after water deprivation (WD). COX-2-deficient (COX-2(-/-), C57BL/6) and wild-type (WT) mice were water deprived for 24 h, and water balance, central AVP mRNA and peptide level, AVP plasma concentration, and AVP-regulated renal transport protein abundances were measured. In male COX-2(-/-), basal urine output and water intake were elevated while urine osmolality was decreased compared with WT. Water deprivation resulted in lower urine osmolality, higher plasma osmolality in COX-2(-/-) mice irrespective of gender. Hypothalamic AVP mRNA level increased and was unchanged between COX-2(-/-) and WT after WD. AVP peptide content was higher in COX-2(-/-) compared with WT. At baseline, plasma AVP concentration was elevated in conscious chronically catheterized COX-2(-/-) mice, but after WD plasma AVP was unchanged between COX-2(-/-) and WT mice (43 ± 11 vs. 70 ± 16 pg/ml). Renal V2 receptor abundance was downregulated in COX-2(-/-) mice. Medullary interstitial osmolality increased and did not differ between COX-2(-/-) and WT after WD. Aquaporin-2 (AQP2; cortex-outer medulla), AQP3 (all regions), and UT-A1 (inner medulla) protein abundances were elevated in COX-2(-/-) at baseline and further increased after WD. COX-2(-/-) mice had elevated plasma urea and creatinine and accumulation of small subcapsular glomeruli. In conclusion, hypothalamic COX-2 activity is not necessary for enhanced AVP expression and secretion in response to water deprivation. Renal medullary COX-2 activity negatively regulates AQP2 and -3. The urine concentrating defect in COX-2(-/-) is likely caused by developmental glomerular injury and not dysregulation of AVP or collecting duct aquaporins.     

The effect of early postnatal sympathectomy on kidney concentrating function in rats

Renal concentrating function has been studied in adult Wistar rats after injections of guanethidine (25 mg/kg) or physiological saline (control) to 1-30 days old rat puppies. Urine osmolality in 30- and 60-day guanethidine-treated rats after test injections of ADH (pituitrin, 5 microU/g) or after water deprivation for 24 h was higher than in control animals. Concentrations of potassium, sodium, and urea were practically equal in all the zones of renal tissue from both groups of rats. The data obtained indicate that renal efferent nerves do not affect significantly the formation of renal concentrating function. It is suggested that elimination of influences of alpha 2-adrenoreceptors, which are antagonistic to the effect of ADH, accounts for the observed increase in antidiuretic effect.     

Body temperature and seawater adaptation in farmed Atlantic salmon and rainbow trout during prolonged chilling

The core temperature of the rainbow trout Oncorhynchus mykiss (3·5 kg) dropped to 1·0° C during the first 6 h of chilling at 0·5° C, remained stable until 24 h, and dropped significantly to 0·7° C after 39 h. Blood plasma osmolality increased and muscle moisture content decreased gradually with increasing chilling time. After 39 h of chilling, the rainbow trout experienced 40 mosmol l^-1 higher blood plasma osmolality and 2·8% less muscle moisture content compared with initial values. In the Atlantic salmon Salmo salar (5·3 kg), core temperature dropped to 1·3° C and blood plasma osmolality increased significantly during the first 6 h of chilling at 0·5° C, but remained relatively stable throughout the rest of the experimental period. After 39 h of chilling, the salmon experienced 20 mosmol l^-1 higher blood plasma osmolality and 0·5% less muscle moisture content compared with initial values. In rainbow trout muscle moisture content was inversely related to blood plasma osmolality indicating reduced seawater adaptation with increasing hours of chilling. No such relationship was observed in the Atlantic salmon. Hence, changes in plasma osmolality and muscle moisture in the Atlantic salmon do not indicate osmoregulatory failure since the new levels, once established, were maintained throughout the chilling time.     

Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years' observation. Birmingham Reflux Study Group.

Children with severe vesicoureteric reflux were allocated randomly to either operative or non-operative treatment and followed up. Altogether 161 children were observed for two years, of whom 104 were followed up for five years. Reflux was abolished in 98% of ureters reimplanted, but more than half of the patients treated non-operatively continued to show severe reflux at five years. Two patients progressed to end stage renal failure, and a further four with extensive bilateral renal scarring became hypertensive. There were no significant differences between treatment groups in the incidence of breakthrough urinary infection, renal excretory function and concentrating ability, renal growth, progression of existing renal scars, or new scar formation. Progressive scarring occurred at all ages but was significantly more common during the first two years'' observation. Furthermore, new scars developed exclusively during the first two years'' observation, affecting 10 children aged 2-7 at allocation. Neither treatment can claim superiority or fully protect the kidneys from further damage, and efforts must continue to be directed towards identifying those at risk before scarring develops.     

An Optimization Algorithm for a Distributed-Loop Model of an Avian Urine Concentrating Mechanism

To better understand how the avian kidney’s morphological and transepithelial transport properties affect the urine concentrating mechanism (UCM), an inverse problem was solved for a mathematical model of the quail UCM. In this model, a continuous, monotonically decreasing population distribution of tubes, as a function of medullary length, was used to represent the loops of Henle, which reach to varying levels along the avian medullary cones. A measure of concentrating mechanism efficiency – the ratio of the free-water absorption rate (FWA) to the total NaCl active transport rate (TAT) – was optimized by varying a set of parameters within bounds suggested by physiological experiments. Those parameters include transepithelial transport properties of renal tubules, length of the prebend enlargement of the descending limb (DL), DL and collecting duct (CD) inflows, plasma Na⁺ concentration, length of the cortical thick ascending limbs, central core solute diffusivity, and population distribution of loops of Henle and of CDs along the medullary cone. By selecting parameter values that increase urine flow rate (while maintaining a sufficiently high urine-to-plasma osmolality ratio (U/P)) and that reduce TAT, the optimization algorithm identified a set of parameter values that increased efficiency by ∼60% above base-case efficiency. Thus, higher efficiency can be achieved by increasing urine flow rather than increasing U/P. The algorithm also identified a set of parameters that reduced efficiency by ∼70% via the production of a urine having near-plasma osmolality at near-base-case TAT.In separate studies, maximum efficiency was evaluated as selected parameters were varied over large ranges. Shorter cones were found to be more efficient than longer ones, and an optimal loop of Henle distribution was found that is consistent with experimental findings.