Compulsive Polydipsia with Defective Renal Concentrating Capacity

Observations are presented on two patients with chronic compulsive polydipsia who showed a relative defect in renal concentrating capacity. After excluding all possible metabolic and renal causes of hyposthenuria and after obtaining normal kidney biopsies, both patients were studied in metabolic balance on a constant diet under the following conditions: (a) dehydration (loss of 3-5% body weight), (b) water loading and response to hypertonic saline, and (c) water loading and response to intravenous vasopressin (Pitressin). Throughout these studies the following parameters were observed: plasma and urine osmolality, glomerular filtration rate (inulin), renal plasma flow (P.A.H.), osmolar clearance and clearance of free water. In both patients the concentration defect was not related to variations in glomerular filtration rate or osmotic load. There was no correlation between the degree of hypoosmolality and the renal concentrating defect. Contrary to reports from other laboratories, restriction of water intake and chronic administration of intramuscular vasopressin did not correct the concentration defect.     

Early changes in renal function following chemically induced nephropathy

The functional changes in the rat kidney 24 h after administration of 2-bromoethanamine hydrobromide (BEA) have been extensively described. There is, however, little information regarding earlier alterations. The present study was designed to measure early changes in renal function in order to clarify further pathomechanisms of the BEA-induced lesion. Experiments were performed in two groups of Wistar rats with different infusion rates during the first 3 h following injection of 100 mg/kg BW BEA compared to sham-injected rats. Analysis included measuring urine flow, osmolality, urea, sodium and potassium as well as inulin and para-aminohippuric acid clearance. Our studies show a tubular as well as a glomerular involvement in BEA-induced nephropathy. A significantly higher urine flow occurred already in the first 30 min following injection of BEA. Urine osmolality began to decrease after 90 min, Na excretion was elevated at 3 h, K excretion was not significantly different from the control group, urea excretion was increased after 30 min. Contrary to other studies we found a continuously decreasing glomerular filtration rate and PAH clearance during the first 3 h. Our results suggest an early effect of BEA on tubular function (increasing sodium excretion), papillary concentration capacity (increasing urine flow combined with decreasing osmolality) and glomerular function (decreasing glomerular filtration rate).     

Effects of water restriction during growth and adulthood on renal function of bobwhite quail,Colinus virginianus

Renal function and osmoregulation were studied in bobwhite quail (Colinus virginianus) raised with unrestricted water (chronically unrestricted group) or restricted water (chronically restricted group). There was no difference in urine concentrating ability between adult and juvenile (3.5 or 7.5 week-old) quail. A filtration marker (polyethylene glycol) was infused into adult quail via osmotic minipumps and responses to the following regimens studied: ad libitum water intake, short-term (4-day) water restriction, and acute (1-day) dehydration (withdrawal of all drinking water). Chronically restricted quail had higher urine-to-plasma ratios of polyethylene glycol and lower urine flow rates during short-term restriction. A greater proportion of the reduction in urine flow rate during dehydration was attributable to enhanced tubular reabsorption, rather than reduced rates of filtration, in chronically restricted than in chronically unrestricted birds. Chronically restricted birds also had higher maximum urine-to-plasma ratios of polyethylene glycol (but not higher urine osmolality). These differences occurred in the face of arginine vasotocin concentrations that were not different in the two groups of birds (approximately 15 pg·ml^-1 during hydration, and 45 pg·ml^-1 during water restriction or dehydration). These observations suggest that chronically restricted quail have an enhanced responsiveness of tubular reabsorption to dehydration, a finding consistent with previous observations of tubule hypertrophy and hyperplasia in these birds (Goldstein and Ellis 1991). Despite this, no difference was found in medullary cAMP levels, either basal or arginine vastotocin-or forskolin-stimulated, in the two groups. When given water ad libitum, chronically restricted quail drank copiously (more than two times the drinking rate of chronically unrestricted birds rehydrating from acute dehydration or short-term water restriction), but glomerular filtration rate, hematocrit, and plasma osmolality did not differ in the two groups under this condition; chronically restricted quail excreted the excess water consumed during rehydration in a copious urine accomplished by reduced tubular water reabsorption.Abbreviations ADH antidiuretic hormone - AVT arginine vasotocin - m_b body mass - cAMP cyclic adenosine-monophosphate - DEH birds raised with restricted water intake - dpm decays per minute - ECF extracellular fluid - ECFV extracellular fluid volume - E _PEG total rate of polyethylene glycol excretion - GFR glomerular filtration rate - Hct hematocrit - HYD birds raised with unrestricted water intake - PEG polyethylene glycol - P _osm plasma osmolality - P _PEG plasma concentration of polyethylene glycol - U _PEG urine concentration of polyethylene glycol - (U/P)_PEG urine-to-plasma ratio concentration of polycthylene glycol - V urine flow rate     

The effect of infusion of hypertonic saline on glomerular filtration rate and arginine vasotocin, prolactin and aldosterone in the domestic chicken

Domestic fowl were infused for 60 min with isotonic saline followed by 90 min with hypertonic saline. Plasma electrolyte concentrations, osmolality and haematocrit were measured. Urine electrolyte excretion rates, osmolar output and urine flow rates were also monitored. From these results fractional excretions of electrolytes were calculated. The renal function markers inulin and ρ-amino hippuric acid were infused to enable the measurement of glomerular filtration rate and plasma clearance of ρ-amino hippuric acid, respectively. Plasma samples were also taken to assay for the hormones prolactin, aldosterone and arginine vasotocin. Plasma electrolytes and osmolality, fractional excretion of electrolytes and osmolar output all increased, while haematocrit decreased, throughout the experiment. However, no significant change was found in urine flow rate and little change was seen in glomerular filtration rate. The clearance of ρ-amino hippuric acid, which provides an indication of renal plasma flow, increased during hypertonic saline infusion. Plasma concentrations of aldosterone and prolactin decreased during the experiment and plasma concentrations of arginine vasotocin increased. Infusion of hypertonic saline had no consistent effect on glomerular filtration rate, which may be due to conflicting influences of expansion of the extracellular fluid volume and increased plasma osmolality. Accepted: 19 January 1998     

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.     

The effects of two analogues of arginine-vasopressin (ornithine-vasopressin and desamino-D-arginine-vasopressin) on kidney function in sheep.

The effects of intravenous infusion of ornithine-vasopressin (OVP) and desamino-D-arginine-vasopressin (dDAVP) were studied in normal and hydrated Merino sheep. In normal sheep, OVP resulted in a diuresis, increased urinary sodium and potassium excretion, and a fall in the plasma potassium concentration. Renal plasma flow remained constant but glomerular filtration rate and filtration fraction rose markedly. dDAVP in normal sheep was antidiuretic, but its only significant effect was a small decrease in plasma osmolality. In the hydrated sheep OVP was antidiuretic and resulted in increased urinary excretion of sodium and potassium, and a fall in the plasma potassium level. Renal plasma flow fell, but glomerular filtration and filtration fraction tended to rise. dDAVP in the hydrated sheep was also antidiuretic but urinary sodium and potassium excretion was reduced. Renal plasma flow and glomerular filtration fell, with a small decrease in filtration fraction. These results suggest that the diuretic effect in normal sheep and the electrolyte-excreting effects in both normal and hydrated sheep of OVP are related to the increase in glomerular filtration, which in turn is dependent on the vasopressor activity of the hormone. The increase in glomerular filtration caused by OVP is due to an increase in the filtration fraction of an unchanged renal plasma flow, which could be brought about by an increase in renal efferent arteriolar tone. The effects of hydration of the sheep were the conventional increased urine flow, decreased urine osmolality and decreased solute-free water reabsorption. Sodium and potassium excretion rose slightly and plasma osmolality fell. Renal plasma flow and glomerular filtration both increased with little change in filtration fraction. These effects could be brought about by suppression of endogenous vasopressin and a decrease in both afferent and efferent renal arteriolar tone.     

Renal excretion of urea in a small east African antelope, the dik-dik (Rhynchotragus kirkii)

1. A study on the renal handling of urea by the dik-dik antelope (Rhynchotragus kirkii) was conducted. 2. Plasma and urine samples were analysed for osmolality, urea and creatinine concentrations during dehydration and intra-ruminal loading of potassium and sodium solutions. 3. The glomerular filtration rate (GFR) of the dik-dik was found to be 182.6 +/- 11.7 ml/min/100 kg body mass. 4. Dehydration was observed to increase tubular urea reabsorption and increase plasma and urine osmolalities, but had no effect on the amount of urea filtered at the glomerulus. 5. Potassium loading increased both GFR and urine flow rate.     

Renal function and organic anion and cation transport during dehydration and/or food restriction in chickens

The effect of dehydration in the presence or absence of continued food intake on renal function was evaluated in chickens. In addition, renal transport of organic anions and cations under these conditions was assessed in vitro by uptake of ¹⁴C-para-aminohippuric acid and ¹⁴C-tetraethylammonium bromide by renal slices. Water restriction with continued food intake resulted in increases in serum osmolality and serum concentrations of sodium, uric acid, calcium and total protein. If food was restricted in addition to water, only serum osmolality and sodium concentration were significantly increased after 48 hours. Dehydration with continued access to food resulted in marked decreases in extracellular fluid volume, glomerular filtration rate and effective renal plasma flow. If food was restricted during dehydration, the decrease in effective renal plasma flow was attenuated despite reductions in glomerular filtration rate and extracellular fluid comparable to that seen in dehydrated birds allowed free access to food. Transport of organic anions was significantly increased after 24 and 48 hours of water restriction, regardless of whether food was withheld. Enhanced transport of organic anions in the presence of decreased glomerular filtration rate and effective renal plasma flow during dehydration may promote precipitation of urates and nephrosis in chickens.Abbreviations cpm counts per minute - dpm disintegrations per minute - ECF extracellular fluid - ERPF effective renal plasma flow - GFR glomerular filtration rate - PAH para-aminohippuric acid - SEM standard error of the mean - TEA tetraethylammonium bromide     

Renal Function in Dogs With Pyometra

Renal function studies on bitches with pyometra and normal bitches have included determinations of glomerular filtration rate (GFR), effective renal plasma flow (ERPF), solute excretion rate per unit functioning renal mass, maximum urine osmolarity (max. Uosm), and — for the normal bitches — max. Uosm after increasing osmotic load with mannitol infusions. GFR for the pyometra bitches varied from normal to greatly reduced values; the mean GFR was statistically significantly lower than that for normal bitches. There were also wide variations in ERPF; there was no significant deviation from normal values but the two pyometra bitches with the greatest reduction in GFR also had greatly reduced ERPF values. The ratio between GFR and ERPF (filtration fraction) varied within normal limits but there was a tendency towards reduction (0.05 < P < 0.01). After dehydration the max. Uosm for all the pyometra bitches was below the lower limit for max. Uosm for normal bitches. The rates of solute excretion per unit functioning renal mass for most bitches with pyometra were less than the level (468 µ Osm/min./100 GFR) above which the osmotic load begins to reduce max. Uosm in normal bitches. Even in those bitches in which the solute excretion rate reached values over 468 µOsm/min./100 GFR (because of reduction in the number of functioning nephrons) max. Uosm was far below the max. Uosm values for normal dogs at the same rates of solute excretion. Consequently, in bitches with pyometra, factors other than osmotic diuresis appear to be mainly responsible for the reduction in concentrating ability and polyuria.     

Seasonal changes in glomerular filtration rate in Antechinus stuartii (Marsupialia: Dasyuridae)

The small marsupial Antechinus stuartii experiences a synchronised life cycle that culminates in complete male mortality (within 3 weeks) following the 1 week mating period in mid-August (late winter). There are pronounced physiological changes in male A. stuartii over the life cycle and renal function was assessed for correlation with these changes. Glomerular filtration rate and urine and plasma electrolytes were determined in male and female A. stuartii in February, May, July and August. Females showed little change in glomerular filtration rate, except for pre-mating values in August which decreased. In contrast, glomerular filtration rate of males decreased significantly in July and August. Plasma sodium and chloride levels were higher in males than females and were higher in animals in July and August than in February and May. Plasma potassium levels dropped in both males and females in July and August. Plasma osmolality was higher in animals in February compared to animals from May and August. However, there were no significant sex or seasonal differences in urine electrolytes, although urea concentration was higher in females than males. Urine osmolality was higher in both sexes in July and August. There were no significant differences in total excretory rates of sodium, potassium or chloride between sexes or between seasons. Many of the alterations in renal function are correlated with known physiological and hormonal profiles in A. stuartii. This is the first observation of seasonal changes in glomerular filtration rate that are unrelated to dietary and water stresses. Accepted: 8 September 1997     

Renal concentrating capacity is linked to blood pressure in children with autosomal dominant polycystic kidney disease

Impaired glomerular filtration rate (GFR) is a risk factor for the development of hypertension in patients with autosomal dominant polycystic kidney disease (ADPKD). However, markers of tubular function were not tested whether they are linked to hypertension or blood pressure (BP) level. The aim of our study was to investigate the relationship between renal concentrating capacity and BP in children with ADPKD. Fifty-three children (mean age 11.8+/-4.4 years) were investigated. Standardized renal concentrating capacity test was performed after nasal drop application of desmopressin, BP was measured by ambulatory BP monitoring (ABPM). Renal concentrating capacity was decreased in 58 % of children. The prevalence of hypertension was significantly higher in children with decreased renal concentrating capacity (35 %) than in children with normal renal concentrating capacity (5 %) (p<0.05). Significant negative correlations were found between renal concentrating capacity, ambulatory BP and number of renal cysts (r = -0.29 to -0.39, p<0.05 to p<0.01). In conclusion, the concentrating capacity is decreased in about half of the patients and is linked to BP. Decreased renal concentrating capacity should be considered.     

Urinary Concentrating Ability in Women with Asymptomatic Bacteriuria in Pregnancy

The incidence of impaired renal concentrating ability in pregnant women with asymptomatic significant bacteriuria is significantly less than previously reported when osmolality readings are performed on every urine specimen obtained during the 24 hours'' deprivation of fluids. The concentrating defect is more considerable as pregnancy progresses. The lower the maximum urinary osmolality the more difficult is the treatment of the patient, and the higher the incidence of acute pyelonephritis.     

Renal function and plasma arginine vasotocin during an acute salt load in feral chickens

Summary Renal clearance experiments were conducted on feral chickens descended from birds collected from a coral island off the coast of Queensland, Australia. Following a control period when 0.13 M NaCl was used as a vehicle for the renal function markers, a salt load was imposed by infusion of 1 M NaCl. The hypertonic NaCl infusion resulted in increases in glomerular filtration rate (GFR), effective renal blood flow (ERBF), and urine flow rate (V), whereas filtration fraction decreased. Haematocrit was reduced and plasma osmolality, sodium, chloride and potassium concentrations increased. Plasma arginine vasotocin (P_AVT) levels increased from 31.4±2.3 pg·ml^-1 during the control infusion to 56.0±1.7 pg·ml^-1 following a salt load of 12 mmol Nacl·kg^-1 The sensitivity of release of AVT was 0.69±0.11 pg·ml^-1 per mosmol·kg^-1. The concentrations of Na and Cl in urine increased, whereas urine osmolality and potassium concentration decreased. The expansion of the extracellular fluid volume induced by the salt loading would tend to suppress the release of AVT, whereas the osmotic stimulus would provide a stimulus for the release of AVT. In this study, GFR, ERBF and ERPF increased at the same time as P_AVT increased.Abbreviations AVP arginine vasopressin - AVT arginine vasotocin - ERBF effective renal blood flow - ERPF effective renal plasma flow - GFR glomerular filtration rate - P_avt plasma arginine vasotocin concentration - PAH paraaminohippuric acid - SEM standard error of mean - SNGER single nephron glomerular filtration rate - U/P urine to plasma ratio - V urine flow rate     

Osmoregulatory responses of glaucous-winged gulls (Larus glaucescens) to dehydration and hemorrhage

The effects of dehydration and hemorrhage on plasma ionic, osmotic, and antidiuretic hormone (arginine vasotocin) concentrations and of hemorrhage on salt gland secretion and glomerular filtration rate were evaluated in glaucous-winged gulls, Larus glaucescens. Dehydration for 24 h did not affect plasma ionic, osmotic or arginine vasotocin concentrations; 72 h dehydration significantly elevated plasma osmolality, plasma sodium and chloride concentrations, and plasma arginine vasotocin concentration, but did not affect plasma potassium concentration. Constant infusion of 0.8 mol·l^-1 NaCl increased plasma arginine vasotocin concentration and produced salt gland secretion in seven gulls; four secreted well, while three secreted less well. Removal of 20% blood volume during saline infusion immediately reduced (P<0.001) salt gland secretion rate in all gulls. After bleeding, good secretors maintained glomerular filtration rate and urine flow rate; the poorer secretors increased glomerular filtration rate and became diuretic. Blood replacement returned salt gland secretion rate to the prebleeding level (P<0.05) without affecting salt gland secretions sodium concentration in gulls which secreted well, but did not restimulate salt gland secretion in gulls which secreted poorly. Reinfusion of blood had no effect on glomerular filtration rate. Bleeding and blood replacement did not affect plasma arginine vasotocin concentration.Abbreviations AVT arginine vasotocin - ECF extracellular fluid - ECFV extracellular fluid volume - EDTA ethylenediaminetetra-acetate - EWL evaporative water loss - GFR glomerular filtration rate - Hct hematocrit - LB large blood sample - [Na⁺]_pl plasma sodium concentration - Osm_pl plasma osmolality - PEG polyethylene glycol - RH relative humidity - RIA radioimmunoassay - SB small blood sample - SGS salt gland secretion - T _a ambient temperature - TFA trifluoroacetic acid - UFR urine flow rate     

Effect of prostaglandin inhibition on glomerular filtration rate in normal and uremic rabbits

Studies were performed to assess the effect of alterations in prostaglandin biosynthesis on glomerular filtration rate in rabbits with normal renal function and after surgical reduction of renal mass. In normal animals, the administration of either of two cyclo-oxygenase inhibitors resulted in a 53% reduction in urine prostaglandin E excretion, but no change in creatinine clearance. Creatinine clearance rates were almost 71% lower in the uremic animals when compared to the animals with normal renal function. Despite the reduction in renal mass, urine prostaglandin E excretion rates in the uremic animals were over twice that seen in normal rabbits. When factored by either glomerular filtration rate or remaining renal mass, urine prostaglandin E excretion rates in uremic rabbits when compared to normal animals were increased more than 9-times and 4-times respectively. Administration of cyclo-oxygenase inhibitors in the uremic animals resulted in a 71% decrease in urine prostaglandin E excretion and, unlike the non-uremic animals, a 53% fall in creatinine clearance. These findings suggest that intact renal prostaglandin biosynthesis is a necessary factor in the homeostatic adaptive mechanisms which maintain the glomerular filtration rate in animals with decreased renal mass.     

The effect of maternal fluid intake on the volume and composition of fetal urine

The effects on fetal renal function of restricting maternal water intake to 1 l/day for 6 days was investigated in 7 chronically-catheterized fetuses (gestation age 118-131 days). Restriction of water intake caused a significant decrease in maternal urine flow rate and significant increases in maternal plasma and urinary osmolality. Fetal renal function was investigated on the third and sixth days of the period of restricted maternal intake of water. Urine flow rate from the fetus was depressed significantly, and urinary osmolality increased significantly. The glomerular filtration rate remained unchanged, and free water clearance was decreased. These changes indicate increased water reabsorption in the distal parts of the nephron, probably consequent upon increased circulating levels of antidiuretic hormone. In 3 fetuses whose mothers subsequently had free access to water, these changes in urine flow rate and free water clearance that occurred during water restriction were reversed. There was an inverse correlation between maternal plasma osmolality and fetal free water clearance corrected for glomerular filtration rate. It is concluded that when water intake by a pregnant animal is restricted, the availability of water to the fetus is reduced and fetal sheep respond by producing a concentrated urine.     

The effects of clonidine on the kidney function in the anesthetized dog

Studies were performed to determine the mechanism by which the antihypertensive agent clonidine increased urine flow. The response of the kidney has been examined in four combinations. The parameters of renal function have been compared during volume expansion by 1.5-2.0% body weight Ringer solution. In the control animals, volume expansion by 2% body weight, resulted in a slight increase in sodium excretion and urine flow. In 10 anesthetized dogs 1.0 microgram/kg/min of clonidine infused i.v. during 30 minutes (the total amount of clonidine infused was 30 micrograms/kg) decreased the arterial blood pressure from 136 +/- 13 mmHg to 127 +/- 12 mmHg and elevated urine flow from 2.95 +/- 1.65 ml/min to 4.34 +/- 1.77 ml/min while the urine osmolality diminished from 399 +/- 107 mosm/l to 265 +/- 90 mosm/l and the glomerular filtration remained constant. In 5 animals 0.1 microgram/kg/min of clonidine was infused into the left renal artery (this dose is corresponding to the renal fraction of the cardiac output) without any effects in the left kidney. 1.0 microgram/kg/min of clonidine infused directly into the left renal artery produced vasoconstriction in the ipsilateral kidney, decreased the glomerular filtration rate and the urine flow. By contrast in the right kidney the urine flow rose without hemodynamic changes, and the urine osmolality became hypoosmotic compared to the plasma. In ten dogs 1.0 microgram/kg/min of clonidine and 1 mU/kg/min of arginine-vasopressin were infused intravenously. The vasopressin infusion superimposed on the clonidine could not inhibit the increase of the urine excretion, and the fall of the urine osmolality. The results suggest that the clonidine increases the renal medullary blood flow possibly via a direct mechanism, decreases the sympathetic outflow to the kidney and via an indirect pathway, mediated by the renin-angiotensin system. The renal medullary flow increase produces a washout of the medullary osmotic gradient, and the water reabsorption diminishes.     

Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate,glomerular filtration rate,and end stage renal failure in chronic renal disease in patients without diabetes.

OBJECTIVE: To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic patients with chronic nephropathy. DESIGN: Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term. SETTING: Research centre in Italy. SUBJECTS: 177 non-diabetic outpatients with chronic renal disease screened for participation in the ramipril efficacy in nephropathy study. MAIN OUTCOME MEASURES: Rate of decline in filtration rate evaluated by repeated measurements of unlabelled iohexol plasma clearance and rate of progression to renal failure. RESULTS: Protein:creatinine ratio was significantly correlated with absolute and log transformed 24 hour urinary protein values (P = 0.0001 and P < 0.0001, respectively.) Ratios also had high predictive value for rate of decline of the glomerular filtration rate (univariate P = 0.0003, multivariate P = 0.004) and end stage renal failure (P = 0.002 and P = 0.04). Baseline protein:creatinine ratios and rate of decline of the glomerular filtration rate were also significantly correlated (P < 0.0005). In the lowest third of the protein:creatinine ratio (< 1.7) there was 3% renal failure compared with 21.2% in the highest third (> 2.7) (P < 0.05). CONCLUSIONS: Protein:creatinine ratio in spot morning urine samples is a precise indicator of proteinuria and a reliable predictor of progression of disease in non-diabetic patients with chronic nephropathies and represents a simple and inexpensive procedure in establishing severity of renal disease and prognosis.     

Role of vasopressin in the modifications of renal function during aging]

In the course of aging, the renal concentrating ability is markedly reduced. This defect may result from an inappropriate synthesis of antidiuretic hormone in the central nervous system or may be due to an impaired renal response to vasopressin. The two hypotheses have been studied in vivo in rats and in vitro in mice. The results of these studies indicated that: 1) dehydration induces a comparable release of vasopressin along the hypothalamo-hypophysial axis in 10, 20 and 30 month-old rats; 2) there is no change with age of the number of nephrons, single nephron filtration rate or transport capacity of Henle's loop of cortical nephrons which could account for an impaired renal response to vasopressin; 3) the reduced concentrating ability of the kidney appears to be linked to a decreased response of the medullary thick ascending limb of Henle's loop which in part is responsible for the cortico-papillary gradient of solutes within the kidney.     

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.