deamino-arginine-vasopressin and Kidney-Diseases

Renal colic affects up to 12% of the population. Initial management of most patients is expectant. Acute symptom management of renal colic is best accomplished with a combination of parenteral opioids and NSAIDs. The elderly patient with a kidney stone should be screened for contraindications to NSAID therapy, such as renal failure or previous peptic ulcer disease. Use of parenteral opioids is often necessary during the acute setting, and downward-adjusted doses and monitoring are necessary to prevent associated confusion and respiratory depression. Novel therapy with desmopressin may also be effective for symptom control at the initial presentation, without the adverse effects of opioids or NSAIDs. However, use of desmopressin in the elderly must be undertaken cautiously, given the potential adverse effects of this agent. Many small, distal ureteral stones are treated initially with watchful waiting for the first 2-4 weeks after presentation. The patient should have effective, non-parenteral analgesics for use at home. Included in these agents are oral or suppository NSAIDs and oral opioids. Medical expulsion therapy with alpha-adrenoceptor antagonists or calcium channel antagonists is efficacious. alpha-Adrenoceptor antagonists such as the alpha(1A/)(1)(D)-selective tamsulosin are well tolerated in the elderly and increase the rate of spontaneous stone passage by approximately 50% for small distal stones. These agents also appear to decrease the severity of renal colic. Corticosteroids and calcium channel antagonists are also effective but their use in the elderly is not recommended as first-line therapy.

Topics: Adrenal Cortex Hormones; Adrenergic alpha-Antagonists; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Calcium Channel Blockers; Colic; Deamino Arginine Vasopressin; Humans; Kidney Diseases; Renal Agents

Topics: Deamino Arginine Vasopressin; Glomerular Filtration Rate; Humans; Kidney; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Pyelonephritis; Radiography; Radioisotope Renography; Renal Agents; Renal Artery Obstruction; Renal Circulation; Ultrasonography

Topics: Animals; Blood Loss, Surgical; Deamino Arginine Vasopressin; Factor VIII; Female; Hemophilia A; Hemorrhage; Hemorrhagic Disorders; History, 18th Century; History, 20th Century; Humans; Italy; Kidney Diseases; Liver Diseases; Male; Platelet Adhesiveness; Rabbits; von Willebrand Diseases; von Willebrand Factor

Bleeding events are the most common complications after kidney biopsy. This study aims to evaluate the effect of desmopressin administration on bleeding complication, in native kidney biopsy candidates with reduced kidney function.. This double-blind randomized clinical trial enrolled 18 to 80 years old patients with 15 < eGFR < 90 mL/min/ 1.73m² from July 2017 to August 2020. Patients were randomly assigned to receive either 3 µg/kg of intranasal desmopressin acetate or 1 mL/kg of intranasal sodium chloride 0.65%, one hour before ultrasound-guided, percutaneous native kidney biopsy. The primary outcome was the post-biopsy bleeding complications, and secondary outcomes were the volume of perirenal hematoma, and changes of post-biopsy hemoglobin and hematocrit level, plasma sodium and blood pressure (Clinical Trial Registration ID: IRCT20090701002112N3).. A total of 120 patients (58 men and 62 women), 60 patients in each group, were analyzed. The mean age and eGFR of the patients were 45.29 ± 15.95 years and 51.77 ± 18.02 ml/min/ 1.73m², respectively. Desmopressin administration significantly decreased post-biopsy perirenal hematoma compared to placebo (7/60 [11.6%]) vs. 33/60 [40%]; P < .05), and the hematoma volume was significantly smaller in the desmopressin group, in case of hematoma formation (2.31 ± 1.17 vs. 7.72 ± 5.45 mm³, P < .05).. Desmopressin administration before kidney biopsy is a safe and effective strategy to prevent bleeding complications. Considering absolute risk reduction of about 28%, the number needed to treat is about 4 procedures. We recommend considering desmopressin administration before percutaneous native kidney biopsy.  DOI: 10.52547/ijkd.6966.

Topics: Adult; Biopsy; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hematoma; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Ultrasonography, Interventional; Young Adult

Bleeding complications occur in one-third of percutaneous kidney biopsies and increase costs of the hospital stay. The aim of the study was to evaluate the effect of prebiopsy administration of desmopressin acetate versus placebo in the incidence of postbiopsy bleeding complications.. Double-blind randomized controlled clinical trial.. We enrolled all patients with serum creatinine level ≤1.5 mg/dL and/or estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) and normal coagulation parameters undergoing ultrasound-guided biopsy of the native kidney in our unit from August 2008 to December 2009.. We examined prebiopsy subcutaneous administration of desmopressin acetate, 0.3 μg/kg, compared with placebo.. The primary outcome was incidence of bleeding complications. Secondary outcomes were hematoma size, postbiopsy hemoglobin level, coagulation parameters, glomerular filtration rate, blood pressure, and length of hospital stay.. 162 adult patients (88 men and 74 women) were enrolled; 80 were allocated to desmopressin treatment, and 82, to the placebo group. Desmopressin compared with placebo significantly decreased the risk of postbiopsy bleeding (11 of 80 [13.7%] vs 25 of 82 [30.5%]; relative risk, 0.45; 95% CI, 0.24-0.85; P = 0.01), hematoma size (median, 208 [25th-75th percentile, 120-300] vs 380 [25th-75th percentile, 270-570] mm(2); P = 0.006] in the 36 patients who experienced bleeding, and mean hospital stay (4.9 ± 1.1 vs 5.9 ± 1.7 days; P = 0.004); postbiopsy hemoglobin levels were not affected significantly in either group.. Single-center design of the study.. Prebiopsy desmopressin administration decreases the risk of bleeding and hematoma size in patients undergoing percutaneous kidney biopsy without a cost increase.

Topics: Adult; Biopsy; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Hemorrhage; Hemostatics; Humans; Incidence; Injections, Subcutaneous; Kidney; Kidney Diseases; Male; Retrospective Studies; Treatment Outcome; Ultrasonography

To evaluate the influence of renal impairment on the pharmacokinetics of desmopressin.. Twenty-four subjects were enrolled in the study, 18 with varying degrees of renal impairment and six healthy volunteers. Each subject received a single intravenous dose of 2 microg desmopressin. Blood and urine samples were collected for 24 h and assayed for desmopressin by radioimmunoassay. Plasma concentrations and the amounts of desmopressin excreted in the urine were analysed simultaneously by use of mixed effects modelling.. Only mild adverse events were observed. Both the renal and the nonrenal clearance of desmopressin were found to vary with the creatinine clearance (CrCL). A decrease of 1.67% in the CrCL (corresponding to 1 ml min(-1) from 60 ml min(-1)) was found to cause a 1.74% decrease in the renal clearance and a 0.93% decrease in the nonrenal clearance. The fall in renal clearance caused the amount of desmopressin excreted in urine to decrease from 47% in healthy subjects to 21% in the patients with severe renal impairment. The mean systemic clearance of desmopressin was 10 litres h(-1) in healthy subjects and 2.9 litres h(-1) in patients with severe renal impairment (difference -7.5 litres h(-1), 95% CI [-11; -4.3] litres h(-1)). Correspondingly, the mean terminal half-life, was 3.7 h in healthy subjects and 10 h in patients with severe renal impairment (difference 6.7 h, 95% CI [4.0; 9.4] h).. Although desmopressin appears to be safe and well-tolerated by patients with impaired renal function, great caution should be exercised when titrating towards an efficient dosage regimen if patients with moderately or severely impaired renal function are to be treated with desmopressin at all.

Topics: Aged; Deamino Arginine Vasopressin; Humans; Infusions, Intravenous; Kidney Diseases; Middle Aged; Prospective Studies; Renal Agents

To assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis.. The study included 61 patients randomized into three different groups; group A received desmopressin (40 microg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale (a 10-cm horizontal scale ranging from 'no pain' to 'unbearable pain') at baseline, 10, 20 and 30 min after administering the treatments.. On admission, the pain level was the same in all three groups. At 10 min the pain decreased in all groups to a level that was not significantly different. At 20 min groups B and C had similar mean pain levels (3.7), whereas in group A it was 5.0. At 30 min, groups B and C scored 2-3, and group A 5.6. All three treatments were equally effective at 10 and 20 min but at 30 min there was a stabilization/slight increase in pain level in group A.. Desmopressin has several advantages, e.g. ease of administration, simplicity of delivery and apparent lack of side-effects, which makes it suitable for ambulatory use. Desmopressin acts rapidly and seems to be effective in both single and combined therapy with diclofenac; it decreases the need for a second treatment and increases the analgesic effect of diclofenac. Some patients responded well to desmopressin, with rapid and complete pain relief. These results indicate that desmopressin may be used to treat renal colic either alone or combined, increasing the analgesic effect of other drugs. More studies are needed to validate and confirm the results; it would also be useful to determine factors that may identify the subgroup of patients who respond quickly and with almost complete pain relief.

Topics: Administration, Intranasal; Anti-Inflammatory Agents, Non-Steroidal; Colic; Deamino Arginine Vasopressin; Diclofenac; Drug Combinations; Female; Humans; Injections, Intramuscular; Kidney Diseases; Male; Middle Aged; Pain Measurement; Renal Agents; Time Factors; Treatment Outcome

This study evaluates the effectiveness of desmopressin renal spray, an antidiuretic drug, in treating patients with acute renal colic. One hundred and eight patients admitted to the emergency room of our hospitals with acute renal colic were included in the study. Each patient, except those with hypertension or other cardiac insufficiency, received 40 micrograms desmopressin intranasal spray. In 58 patients (53.7%) pain was eliminated 30 min after desmopressin administration. Forty-four patients (40.7%) did not respond to desmopressin and received prostaglandin synthesis inhibitors, while another 6 patients required intramuscular pethidine for pain relief. No patient showed any side effects. We conclude that the simplicity and effectiveness of intranasal desmopressin spray in treating renal colic makes this simple method a useful means of confronting a frequent and disturbing urological problem.

Topics: Administration, Intranasal; Adult; Colic; Deamino Arginine Vasopressin; Humans; Kidney Diseases; Middle Aged; Renal Agents

Intranasal administration of desmopressin (dDAVP) is frequently used to test renal concentrating capacity in children. However, the bioavailability of intranasal dDAVP is about 10% and may be modified by nasal congestion. The study aimed to compare the efficacy of intranasal dDAVP with an equivalent dose of intravenous dDAVP for a renal concentrating capacity test in children. We studied 18 children aged 12.6 +/- 3.8 years weighing more than 20 kg in whom a dDAVP test was indicated as part of global renal function evaluation. Spray applicator (Minirin Spray) was used for intranasal administration (20-40 micrograms according to BW); the dose of intravenous dDAVP (Minirin IV) was reduced to 10% (2-4 micrograms according to BW). A randomized sequence was used for the first intranasal or intravenous dDAVP test; the second alternate test was repeated in the same children in a time interval ranging from 1 to 3 weeks. Osmolality of the urine (Uosm, mosm/kg) was determined before (T0), then 2 (T2) and 4 (T4) h after dDAVP administration. There was no significant difference in Uosm at T0 (intranasal = 480 +/- 212, intravenous = 443 +/- 168 mosm/kg), T2 (604 +/- 226 and 542 +/- 173 mosm/kg, respectively), and T4 (657 +/- 206 and 629 +/- 190 mosm/kg, respectively). There was an obvious correlation between intranasal and intravenous Uosm at T4 (r2 = 0.826; p = 0.001). Even if intravenous dDAVP is of theoretical interest, intranasal administration of dDAVP using a spray applicator can be considered as first-choice method for a renal concentrating capacity test in children weighing more than 20 kg.

Topics: Administration, Intranasal; Adolescent; Child; Deamino Arginine Vasopressin; Female; Humans; Infusions, Intravenous; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Male; Time Factors

Desmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study was undertaken to evaluate efficacy of desmopressin in reducing bleeding after percutaneous kidney biopsy.. Retrospective cohort study. 269 of 322 patients undergoing percutaneous kidney biopsy between January 1, 2014 and January 31, 2018 were included. Patients had normal bleeding time, platelet count and coagulation profile. Primary outcome was defined as composite of hemoglobin drop ≥1 g/dL, hematoma on post biopsy ultrasound, gross hematuria, erythrocyte transfusion or angiography to stop bleeding. Association of desmopressin with outcomes was assessed using linear (for continuous variables) and logistic (for binary variables) regression models. Propensity score was used to minimize potential confounding.. Desmopressin was administered to 100/269 (37.17%) patients. After propensity score adjustment patients who received desmopressin had increased odds of post biopsy bleeding [OR 3.88 (1.95-7.74), p < 0.001]. Creatinine at time of biopsy influenced bleeding risk; gender, emergent vs elective biopsy, obesity, AKI, diabetes, hypertension or bleeding time did not influence bleeding risk. Administration of desmopressin to patients with serum creatinine ≥1.8 mg/dL decreased bleeding risk [OR 2.11 (95% CI 0.87-5.11), p = 0.09] but increased bleeding risk when serum creatinine was < 1.8 mg/dL (OR 9.72 (95% CI 2.95-31.96), p < 0.001).. Desmopressin should not be used routinely prior to percutaneous kidney biopsy in patients at low risk for bleeding but should be reserved for patients who are at high risk for bleeding.

Topics: Angiography; Biopsy; Blood Coagulation; Creatinine; Deamino Arginine Vasopressin; Female; Hemostasis, Surgical; Hemostatics; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Selection; Postoperative Hemorrhage; Retrospective Studies; Ultrasonography; United States

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Kidney Diseases; Renal Colic

To evaluate whether the administration of desmopressin alters the risk for renal biopsy complications.. A multicenter registry containing 576 native kidney biopsies (NKb) with a serum creatinine above 150 μmol/L in 527 patients (372 men and 155 women, median age 61 years) was used. Most of the data were prospective. At one of the hospitals all biopsies with creatinine above 150 μmol/L received desmopressin before biopsies (NKb 204). These were compared to outcome of biopsy complications against other centres where desmopressin was not given (NKb 372). Fisher's exact test, χ. In NKb with creatinine >150 μmol/L, those with desmopressin had less overall (3.4% vs 8.4%, OR 0.39, CI 0.17-0.90) whereas major or minor complications were not different. While desmopressin did not exhibit difference in complications in men, women received less major (0% vs 8.6%, P = 0.03) and overall complications (0% vs 12.1%, P = 0.006). A multiple logistic regression revealed that, after adjusting for BMI, age and sex, prophylaxis with desmopressin showed less major (OR 0.38, CI 0.15-0.96) and overall complications (OR 0.36, CI 0.15-0.85).. Desmopressin given before a native kidney biopsy in patients with impaired renal function can reduce the risk for complications.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Chi-Square Distribution; Deamino Arginine Vasopressin; Female; Hemorrhage; Hemostatics; Humans; Kidney; Kidney Diseases; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pilot Projects; Predictive Value of Tests; Prospective Studies; Protective Factors; Registries; Retrospective Studies; Risk Factors; Sweden; Young Adult

We have shown that the capacity for local release of tissue-type plasminogen activator (tPA) from the vascular endothelium is impaired in patients with primary hypertension. Because this response is an important protective mechanism against intravascular clotting, we investigated whether this system is also defective in patients with advanced chronic kidney disease and hypertension. Nine nondiabetic nonsmoking men with chronic kidney disease (glomerular filtration rate 11 to 28 mL/min x 1.73 m2; aged 33 to 75 years) were compared with age-matched healthy controls. Intraarterial infusions of desmopressin, methacholine, and sodium nitroprusside were given locally in the brachial artery. Forearm blood flow was measured by venous occlusion plethysmography and blood collected repeatedly during the desmopressin infusion for determination of stimulated net and total cumulated release of tPA. The maximal release rate of active tPA (P<0.05) and the capacity for acute tPA release were markedly impaired in the renal patients as compared with healthy subjects (ANOVA, P=0.013). Accordingly, the accumulated release of tPA was 1905 (SEM 366) and 3387 (718) ng/L tissue, respectively (P<0.05). However, there were no significant differences in vasodilator responses between the groups. Thus, patients with advanced chronic kidney disease and hypertension have a markedly impaired capacity for acute release of tissue plasminogen activator, despite preserved endothelium-dependent vasodilation. This defect may contribute to a defective local defense against arterial thrombosis.

Topics: Adult; Aged; Brachial Artery; Deamino Arginine Vasopressin; Endothelium, Vascular; Forearm; Humans; Hypertension; Hypertension, Renovascular; Infusions, Intra-Arterial; Kidney Diseases; Male; Methacholine Chloride; Middle Aged; Nitroprusside; Plethysmography; Secretory Rate; Tissue Plasminogen Activator; Vasodilation

Patients with renal colic are usually treated in emergency care units or by their family doctors and require immediate diagnosis and treatment. The life-time risk is up to 10 %. The prevalence amounts to 4.7 % in Germany. In addition to confirming the diagnosis and inducing an adequate pain therapy it's very important for patients to be directed correctly and, above all, prevention is important, too. Without treatment the recurrence rate ranges between 50 and 100 %. Particularly, these principals should give useful advice, wherever patients are treated without urological department.

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Colic; Cyclooxygenase Inhibitors; Deamino Arginine Vasopressin; Diclofenac; Emergencies; Humans; Kidney Calculi; Kidney Diseases; Lithotripsy; Pain; Parasympatholytics; Recurrence; Renal Agents; Risk Factors; Ureteral Calculi; Urinary Calculi

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Colic; Deamino Arginine Vasopressin; Dogs; Humans; Kidney Diseases; Pain; Renal Agents

The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopressin), is a potent antidiuretic without the pressor effects of vasopressin. A total of 18 patients with acute renal colic due to stone disease received 40 microgramsf1p4mopressin intranasal spray with encouraging results. There was a significant decrease in the colic pain intensity from an initial mean visual analogue score of 67 +/- 17 mm. to 39 +/- 36 mm. within 30 minutes (p < 0.001). Eight patients (44.4%) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodium achieved complete pain relief within another 30 minutes. In other words, when intranasal desmopressin spray was administered before diclofenac sodium, 94.4% of the patients achieved complete pain relief and were discharged home. The mechanism of analgesic action of desmopressin in renal colic is uncertain. At the peripheral level, desmopressin may alleviate the acute renal colic through its potent antidiuretic effect or by relaxing the renal pelvic and ureteral smooth muscles. The central analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranasal desmopressin spray can be used successfully in the treatment of renal colic. It may also replace prostaglandin synthetase inhibitors in treating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combination of desmopressin with analgesics or spasmolytic drugs offers competitive results compared with those achieved by prostaglandin synthetase inhibitors in the treatment of renal colic.

Topics: Acute Disease; Administration, Intranasal; Analgesics, Non-Narcotic; Colic; Deamino Arginine Vasopressin; Diclofenac; Drug Therapy, Combination; Humans; Injections, Intramuscular; Kidney Diseases; Male; Pain Measurement

Three hundred four patients with diffuse renal disease underwent 307 consecutive percutaneous biopsies with use of nonenhanced computed tomographic (CT) guidance and the 14-gauge Vim Silverman needle. Satisfactory tissue for histopathologic diagnosis was obtained in 100% of cases. Precise data collection before and after the last 241 biopsies enabled diagnosis of 18 hemorrhagic complications (7.5%). The conditions of five patients stabilized without intervention. Thirteen patients received blood transfusions, and one required therapeutic embolization. One death occurred in a patient with advanced systemic lupus erythematosus. Two nonhemorrhagic complications were fevers after biopsy, both of which resolved without sequelae. Review of medical records revealed increased hemorrhagic complication rates in dialysis patients, female patients, patients who underwent left-sided biopsies, and patients pretreated with 1-deamino-8-D-arginine vasopressin to reverse uremic platelet dysfunction. No complications were associated with biopsies in 14 pediatric patients (younger than 16 years) and 10 renal transplant recipients. Risk of hemorrhagic complications had no correlation with patient age (when older than age 16 years) and 10 renal transplant recipients. Risk of hemorrhagic complications had no correlation with patient age (when older than age 16 years), creatinine level, hematocrit, pathologic features of resultant biopsy specimen, or whether the patient was admitted solely for the biopsy.

Topics: Adult; Biopsy, Needle; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Kidney; Kidney Diseases; Male; Needles; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Genes; Genetic Testing; Humans; Kidney Diseases; Male; Renin

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Female; Humans; Indomethacin; Kidney Diseases; Middle Aged

Two brothers, patient 1 with fever and vomiting, and patient 2 with failure to gain weight were studied. After 4 hr of water deprivation test, the urinary osmolality of the patient 1 was only 105 mOsm/liter and his body weight showed a 4.6% reduction. In response to desamino-8-D arginine vasopressin intranasal administration, no significant elevation of urinary osmolality of patient 1 occurred. After low dose vasopressin tests, the maximal urinary osmolality of their father was in the normal range, but that of their mother was below the normal range. Moreover, the patients showed no significant increase of urinary osmolality after the same tests. The brothers were diagnosed as nephrogenic diabetes insipidus (NDI) and their mother was diagnosed as a carrier. An early diagnosis of NDI is important, since adequate managements such as low-solute diet with restricted protein and salt intake or such as water intake at frequent intervals can prevent the hyperosmolality which would develop the delayed mental and physical developments. The usefulness of the combination of indomethacin with thiazide diuretics is described.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Osmolar Concentration; Pedigree; Urine; Water Deprivation

Fibrinolytic responses to infusion of 1-desamino-8-D-arginine-vasopressin (DDAVP) were assessed in 6 males with congenital nephrogenic diabetes insipidus (NDI), 6 carriers of the NDI gene and 6 normal control subjects. Tissue-type plasminogen activator (t-PA) activity and antigen increased significantly in normal subjects, while plasminogen activator inhibitor (PAI) activity decreased. None of these changes were observed in patients with NDI. In 2 female carriers, normal fibrinolytic responses were seen, while in the other carriers responses were delayed. These findings are consistent with the concept of a general V2-receptor defect in congenital NDI. DDAVP tests are of limited use in NDI carrier detection.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fibrinolysis; Humans; Kidney Diseases; Male; Plasminogen Inactivators; Tissue Plasminogen Activator

Individuals receiving lithium carbonate commonly have nephrogenic diabetes insipidus. There is no effective and practical treatment for this condition. We have found that large doses of desmopressin (DDAVP) may provide effective therapy without adverse effects. A recent report showed that indomethacin improved nephrogenic diabetes insipidus that had persisted after the lithium therapy was discontinued. We have provided additional evidence that indomethacin may be effective, even when treatment with lithium is continued. We also have shown that indomethacin together with desmopressin can markedly decrease polyuria, though indomethacin must be used with care because it may impair renal function.

Topics: Adult; Antiviral Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Drug Synergism; Drug Therapy, Combination; Female; Humans; Indomethacin; Injections, Subcutaneous; Kidney Diseases; Lithium; Lithium Carbonate; Osmolar Concentration

Three patients with congenital, nephrogenic diabetes insipidus (NDI) from two unrelated families were tested for haemostatic and fibrinolytic responses to DDAVP infusion and venous occlusion. None of the three patients showed a response of factor VIII:C, vWF:Ag or t-PA to DDAVP, a V2-agonist. However, the baseline levels of these factors in the patients' plasma were normal and during venous occlusion a rise in t-PA antigen and t-PA activity was observed in all patients. One patient showed a definite response of the t-PA antigen level to exercise. It is concluded that (extrarenal) V2-receptor-mediated responses are absent in these patients, but that baseline homeostasis and the response to venous occlusion and physical exertion are intact. Presumably, these depend on other mechanisms. This observation denies a central role for vasopressin receptors in the on-demand regulation of clotting and clot dissolving properties of the blood.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Fibrinolysis; Homeostasis; Humans; Kidney Diseases; Male; Plasminogen Inactivators; Receptors, Angiotensin; Receptors, Vasopressin; Tissue Plasminogen Activator

To determine the value of screening for bacteriuria in infants with special emphasis on the natural course of untreated asymptomatic bacteriuria, renal growth, and renal damage.. Prospective six year follow up of infants with bacteriuria on screening in an unselected infant population.. Paediatric outpatient clinic.. 50 Infants (14 girls, 36 boys) with bacteriuria on screening verified by suprapubic aspiration from an unselected population of 3581 infants in a defined area of Gothenburg.. Children with asymptomatic bacteriuria and normal findings on initial urography were untreated, although other infections were treated.. Culture of urine and determination of C reactive protein concentration every six weeks for the first six months after diagnosis, every three months from six months to two years, and every six months between two and three years; thereafter yearly urine culture. Evaluation of renal concentrating capacity with a desmopressin test; radiological examination, including first and follow up urography and micturition cystourethrography without antibiotic cover; and measurement of renal parenchymal thickness and renal surface area.. Of the original 50 infants, 37 (12 girls, 25 boys) were followed up for at least six years. Two infants developed pyelonephritis within two weeks after bacteriuria was diagnosed; the others remained free of symptoms. 45 Infants were untreated; the bacteriuria cleared spontaneously in 36 and in response to antibiotics given for infections in the respiratory tract in eight. Recurrences of bacteriuria were observed in 10 of the 50 children, of whom one had pyelonephritis. No child had more than one recurrence. At follow up urography in 36 of the 50 children (9 girls, 27 boys) after a median of 32 months no child had developed renal damage. First samples tested for renal concentrating capacity showed significantly higher values than those from a reference population (mean SD score 0.50, 95% confidence interval 0.21 to 0.79; p less than 0.001), but the last samples showed no significant difference (mean SD score 0.08, -0.24 to 0.40; p greater than 0.05).. Mass screening for bacteriuria in infancy results primarily in detection of innocent bacteriuric episodes and is not recommended.

Topics: Algorithms; Bacteriuria; C-Reactive Protein; Cicatrix; Deamino Arginine Vasopressin; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Mass Screening; Prospective Studies; Pyelonephritis; Recurrence; Time Factors; Urography

An early diagnosis of renal dysfunction is particularly important in patients with chronic abuse of analgesics. First morphological changes in cases of analgesic nephropathy are found in the renal medulla. Therefore, urinary osmolarity as well as the urinary excretion of cyclic adenosine monophosphate (AMP) and kallikrein were measured after application of desamino-D-arginine vasopressin (DDAVP) as parameters of the renal tubular function in 21 patients with normal creatinine clearance and a regular, excessive use of analgesics. The results were compared with those of 17 healthy volunteers and 8 patients with chronic renal insufficiency after analgesic nephropathy. In patients with analgesic nephropathy the urine osmolarity after 12 h of thirst was 367 +/- 28 mOsm/kg and did not increase after DDAVP. The results obtained from healthy volunteers were 781 +/- 39 mOsm/kg. Half of the patients with chronic misuse of analgesics had lower values of urine osmolarity after thirst and DDAVP compared to the reference area of healthy subjects. Similar results were found when the effect of DDAVP under conditions of water-loading was tested. The excretion of cyclic AMP as a second messenger of DDAVP and of kallikrein did not differ between patients with chronic abuse of analgesics and healthy volunteers. The excretion of kallikrein in patients with manifest analgesic nephropathy, however, was decreased. Thus the renal concentration test with DDAVP proved to be useful in early diagnosis of renal dysfunction caused by analgesics.

Topics: Adult; Analgesics, Opioid; Chronic Disease; Cyclic AMP; Deamino Arginine Vasopressin; Female; Humans; Kallikreins; Kidney Diseases; Male; Middle Aged; Osmolar Concentration; Substance-Related Disorders; Time Factors

Topics: Deamino Arginine Vasopressin; Hemorrhagic Fever with Renal Syndrome; Humans; Kidney Diseases

The antidiuretic hormone arginine vasopressin interacts with two types of receptors: V1, which mediates the effects of vasopressin on vascular smooth muscle, and V2, which mediates the antidiuretic effects on renal tubules. Resistance of the renal tubules to arginine vasopressin and to the antidiuretic V2-specific agonist 1-desamino[8-D-arginine] vasopressin (dDAVP) occurs in congenital nephrogenic diabetes insipidus, a rare X-linked disease, although the V1-receptor responses remain intact. The extrarenal actions of dDAVP in normal persons are a decrease in blood pressure, an increase in plasma renin activity, and stimulation of the release of factor VIIIc and von Willebrand factor. We measured the response of mean arterial pressure, pulse rate, plasma renin activity, factor VIIIc, and von Willebrand factor to an infusion of dDAVP (0.3 microgram per kilogram of body weight) in seven male patients with congenital nephrogenic diabetes insipidus, six obligatory carriers of the gene for nephrogenic diabetes insipidus, five patients with central diabetes insipidus, and four normal subjects. In the normal subjects and the patients with central diabetes insipidus, dDAVP decreased mean arterial pressure (by 10 to 15 percent) and increased pulse rate (by 20 to 25 percent), renin activity (by 65 percent), and the release of coagulation factors (twofold to threefold) (all changes were significant, P less than 0.01). None of these changes were observed in the patients with congenital nephrogenic diabetes insipidus, and minimal responses were observed in the obligatory carriers. These results confirm the existence of extrarenal vasopressin V2-like receptors, which may be defective in patients with congenital nephrogenic diabetes insipidus.

Topics: Arginine Vasopressin; Blood Coagulation; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Hemodynamics; Humans; Kidney Diseases; Kidney Tubules; Male; Pulse; Receptors, Angiotensin; Receptors, Vasopressin; Renin; von Willebrand Factor

V1 and V2 vasopressin receptor functions were studied in 2 patients with congenital nephrogenic diabetes insipidus. V1 receptor-mediated functions (increase in urinary prostaglandin E2 excretion and plasma cortisol levels) and Gs (guanine nucleotide-binding stimulatory protein) activity of erythrocyte membranes were normal in both patients. After infusion of 0.4 micrograms/kg dDAVP, a 57-yr-old male patient had no increase in plasma factor VIII coagulant, ristocetin cofactor, or fibrinolytic activity or change in von Willebrand factor multimers. In addition, he had no vasodilatory response to dDAVP, a response that occurs in normal subjects and patients with central diabetes insipidus. In contrast, a 25-yr-old female patient had normal hemostatic and vasodilatory responses to the infusion of dDAVP. These observations indicate that the cellular abnormalities in patients with congenital nephrogenic diabetes insipidus may be either at the V2 receptor or in the postreceptor (and Gs activity) cascade of events that mediate vasopressin-induced antidiuresis. Therefore, heterogeneity exists in the biochemical cause(s) of congenital nephrogenic diabetes insipidus in man.

Topics: Adult; Biomechanical Phenomena; Blood Coagulation; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Female; Hemodynamics; Humans; Kidney Diseases; Male; Middle Aged; Skin Temperature; von Willebrand Factor

The effects of 1-deamino-8D-arginine vasopressin (DDAVP) on plasma factor VIII and von Willebrand factor (vWF) levels were studied in four patients with nephrogenic diabetes insipidus (NDI) from two unrelated families. While the urine osmolality remained low, the plasma levels of factor VIII and vWF rose 2- to 3-fold after infusion of 0.3 micrograms/kg DDAVP, compared to preinfusion levels. The degree of increase was similar in both NDI patients and normal subjects. We conclude that in NDI patients the end-organ resistance to DDAVP is confined to the kidneys and does not involve the sites from which factor VIII and vWF are released.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Factor VIII; Female; Humans; Infusions, Intravenous; Kidney Diseases; Male; von Willebrand Factor

Substances known or suspected to cause subtle or transient anatomical alterations in renal development were administered prenatally or neonatally to rats in order to determine whether they are capable of altering renal functional development. Colchicine alters mitotic activity and cytoskeletal structure and is teratogenic in many species. Since the kidney of the newborn rat undergoes extensive cellular proliferation and nephron differentiation, it is possible that neonatal administration of colchicine may affect nephron development. Dinoseb and methyl salicylate have previously been reported to produce a high incidence of dilated renal pelvis in the term rat fetus. Colchicine was injected sc, at 75 micrograms/kg, to Postnatal Day (PD) 1 Sprague-Dawley rats. Dinoseb was administered ip to pregnant Sprague-Dawley rats on Gestation Days 10-12 at doses of 8 or 10.5 mg/kg/day, and methyl salicylate was administered ip at doses of 200, 250, or 300 mg/kg/day on Gestation Days 11-12. Renal function was examined in pups from immediately after birth through weaning. Maximal urine concentrating ability was measured after DDAVP (desmopressin acetate, a vasopressin analog) injection in suckling rats, and after 24 hr of water deprivation in weanlings. Proximal tubule transport was measured in renal cortical slices. Basal urinary parameters, including urine flow, osmolality, pH, and chloride content, were measured. Colchicine treatment had no effect on body weight or kidney weight. There was a significant decrease in maximal urine osmolality in PD 30 rats measured after 24 hr of water deprivation. The urine concentrating deficit detected in functionally mature PD 30 rats suggests that colchicine treatment during renal histogenesis causes a latent deficit in medullary function in the absence of any gross morphological effects. The 10.5 mg/kg/day dose of dinoseb caused a weight reduction in neonates which persisted after weaning. Urine volume after DDAVP challenge was increased over controls in both dose groups on PD 6, but maximal urine concentration was unaffected. On PD 14, maximal urine concentration after DDAVP injection was decreased in the 10.5 mg/kg/day group. By PD 30, urine concentrating ability was comparable to controls. Renal cortical slices from the 10.5 mg/kg/day dose group had an enhanced ability to accumulate organic anions on PD 3 and 31, but opposite effects were observed in the low-dose group. No other renal functional parameters were altered. Urine os

Topics: 2,4-Dinitrophenol; Animals; Animals, Suckling; Colchicine; Deamino Arginine Vasopressin; Dinitrophenols; Female; Fetus; Herbicides; Kidney Cortex; Kidney Diseases; Kidney Function Tests; Pregnancy; Prenatal Exposure Delayed Effects; Rats; Rats, Inbred Strains; Salicylates; Teratogens

Nitrofen and ethylenethiourea (ETU), agents known to prenatally induce hydronephrosis in rats, were assessed for their effects on postnatal renal functional maturation. Both were given by gavage to pregnant Sprague-Dawley rats on Gestation Day 11. Nitrofen was given at concentrations of 50 or 100 mg/kg, and ETU at 20, 40, or 60 mg/kg. Renal function was examined in the offspring from birth until after weaning, the period of renal functional maturation in the rat. Maximal urine concentrating ability was measured after DDAVP (desmopressin acetate, a vasopressin analog) challenge or water deprivation. Proximal tubule transport was measured in renal cortical slices. Various urinary parameters were measured. Both prenatal nitrofen and ETU exposure caused a large number of neonatal deaths at the high dose, and hydronephrosis was observed. The severity of the lesion increased with age. Hydronephrotic animals were deficient in urine concentrating ability, which became more pronounced after weaning. A few other urinary parameters were altered, but cortical function appeared to be unaffected. Rats prenatally exposed to nitrofen, but with apparently normal kidneys, were significantly compromised in their ability to produce a concentrated urine in response to DDAVP challenge, on Postnatal Days (PDs) 6 and 14. By PD 30, they were not different from controls in urine concentrating response. Rats prenatally exposed to the higher doses of ETU, but with grossly normal kidneys, had significantly decreased plasma clearances of certain electrolytes early in life, but by PD 27, they were not different from controls. Proximal tubule transport of PAH was increased on PD 7 in ETU-exposed pups, but this effect did not persist.

Topics: Animals; Animals, Newborn; Deamino Arginine Vasopressin; Ethylenethiourea; Female; Gestational Age; Herbicides; Hydronephrosis; Imidazoles; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Kidney Tubules, Proximal; Phenyl Ethers; Pregnancy; Rats; Rats, Inbred Strains; Sodium; Teratogens

A 4-year-old Japanese girl had a congenital disorder that was characterized by recurrent thrombocytopenia, hemolytic anemia, hematuria, and proteinuria, which were repeatedly improved by the infusion of factor VIII concentrate. She developed the similar symptoms within 1 h after 1-desamino-8-D-arginine vasopressin (DDAVP) administration. Coagulation studies 30 and 60 min after DDAVP infusion showed a disappearance of large factor VIII:von Willebrand factor (VIII:vWF) multimers, which was the same abnormality that was observed at acute episodes. There were no significant changes in the plasma levels of 6-keto-prostaglandin F1 alpha and thromboxane B2 before and after DDAVP infusion. These results provide further support that VIII:vWF is directly involved in the pathogenesis of this congenital disorder.

Topics: Anemia, Hemolytic; Child, Preschool; Deamino Arginine Vasopressin; Factor VIII; Female; Humans; Kidney Diseases; Macromolecular Substances; Recurrence; Thrombocytopenia; von Willebrand Factor

We studied two women with severe hypotonic polyuria whose symptoms dated from infancy. We eliminated the possibility of central diabetes insipidus (DI) and primary polydipsia, and established the presence of nephrogenic DI on the basis of: 1) the interrelationships between plasma osmolality, urine osmolality, and urinary AVP; and 2) impaired antidiuretic responses to AVP and 1 deamino-8-D-arginine vasopressin. Though 25-50 times as resistant to 1 deamino-8-D-arginine vasopressin nasal spray as patients with central DI, these patients could be treated effectively with large doses of the nasal spray. One patient has been so treated for more than a year with dramatic improvement in her polydipsia, polyuria, and sense of well-being.

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; Humans; Kidney Concentrating Ability; Kidney Diseases; Polyuria; Thirst

Renal functions were examined in 53 patients before the start of long-term lithium treatment (I) and then after 4 months (II) and 12 months (III) on lithium treatment. The tubular function was studied by means of the DDAVP (Minirin) test and the glomerular filtration rate was measured by creatinine clearance. The mean maximum urine osmolality (+/- SE) on the first occasion (I) was 800 +/- 20 mosm/kg H2O, 702 +/- 20 on the second (II), and on the third (III) 723 +/- 17 mosm/kg H2O. The mean creatinine clearance before the start of lithium treatment (I) was 128 +/- 5 ml/min, after 4 months (II) 106 +/- 4 and after 12 months (III) 114 +/- 5 ml/min. The results of the present study suggest that lithium treatment with serum levels of approximately 0.6 mmol/l causes a decrease in renal concentrating ability and the glomerular filtration rate in the early stages after the start of therapy. This decrease in the renal functions does not seem to progress during the first year of lithium treatment.

Topics: Adult; Aged; Arginine Vasopressin; Creatinine; Deamino Arginine Vasopressin; Female; Glomerular Filtration Rate; Humans; Kidney Concentrating Ability; Kidney Diseases; Lithium; Male; Metabolic Clearance Rate; Middle Aged; Time Factors

Three chemicals, known either to alter renal development when administered during fetal development or to affect renal function when administered to adult rats, were administered to Sprague-Dawley rats at critical periods of renal development. Chlorambucil (CHL) was administered ip on d 11 of gestation at doses of 0, 3, and 6 mg/kg; nitrofen (2,4-dichlorophenyl p-nitrophenyl ether) (NIT) was given po on d 8-16 of gestation at 0, 4.17, 12.5, and 25 mg/kg . d; and mercuric chloride (MER) was given sc on postnatal d 1 at 0, 14, and 28 micrograms/pup. To assess the effects of these toxicants on the functional development of the kidneys, a diuresis test with and without antidiuretic hormone was applied on postnatal d 3 (PD 3); a hydropenia test on PD 6; and kidney weights, glomerular counts in midhilar cross sections, and the specific activity of renal alkaline phosphatase were determined on PD 3 and 6. Data from pups with obvious malformations of the kidneys was eliminated from the statistical analyses of the data so that emphasis could be placed on alterations of functional development in individuals with apparently morphologically normal kidneys. CHL retarded the growth and biochemical differentiation of the kidney at 6 mg/kg. Pups from this treatment groups showed an attenuated response to exogenously administered antidiuretic hormone. NIT impaired growth and altered renal morphology at a dose of 12.5 mg/kg . d and altered physiological responses in the absence of anatomical changes at a dose of 4.17 mg/kg . d. MER, at doses near the maximum tolerated, failed to alter any parameter, indicating that the very young animal differs markedly from the adult in response to that compound. The data indicate that relatively simple tests of renal function are useful in the detection of perinatally induced nephrotoxicity.

Topics: Age Factors; Animals; Animals, Newborn; Chlorambucil; Deamino Arginine Vasopressin; Diuresis; Dogs; Dose-Response Relationship, Drug; Female; Hydronephrosis; Kidney; Kidney Diseases; Male; Mercuric Chloride; Mercury; Phenyl Ethers; Pregnancy; Rabbits; Rats; Rats, Inbred Strains

1. Urinary and plasma levels of adenosine 3':5'-cyclic monophosphate (cyclic AMP) after an intravenous injection of bovine parathyroid hormone (PTH) were measured in 12 patients on long-term lithium treatment and in nine control subjects. The maximum urine osmolality (Umax.) after an intravenous injection of desamino-D-arginine vasopressin (DDAVP) was also measured. 2. In all the control subjects and six of the patients, the Umax. after DDAVP exceeded 700 mosmol/kg. The cyclic AMP responses in these two groups did not differ significantly. 3. In the remaining six patients whose Umax. did not reach 700 mosmol/kg, the cyclic AMP response to PTH was significantly less than that of the controls. 4. A strong correlation was demonstrated in the patients between the urinary cyclic AMP response after PTH and the maximum osmolality after the administration of DDAVP. 5. These observations are consistent with the hypothesis that reduced adenylate cyclase activity contributes to the development of nephrogenic diabetes insipidus in patients on long-term lithium treatment.

Topics: Adult; Aged; Chronic Disease; Cyclic AMP; Deamino Arginine Vasopressin; Female; Humans; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Lithium; Male; Middle Aged; Mood Disorders; Parathyroid Hormone; Time Factors

Topics: Animals; Animals, Newborn; Deamino Arginine Vasopressin; Diuresis; Female; Gestational Age; Herbicides; Hydronephrosis; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Male; Nitrogen; Potassium; Pregnancy; Prenatal Exposure Delayed Effects; Rats; Rats, Inbred Strains; Water Deprivation

Patients given long-term treatment with lithium often develop an impairment of renal water reabsorption which may lead to clinically significant adverse reactions. A convenient measure of this impairment may be obtained using the ratio of urine volume (V) divided by lithium clearance (CLi). When data from a large group of patients were recalculated, this ratio showed a statistically significant correlation with the serum lithium level. This finding supports the suggestion that patients might advantageously be maintained at lower serum levels than those commonly employed.

Topics: Absorption; Body Water; Deamino Arginine Vasopressin; Humans; Kidney Diseases; Lithium; Osmolar Concentration

Two years after a survey of the kidney function in 237 patients given long-term lithium treatment the patients were invited for reexamination. Of 184 patients who came for the reexamination 147 had continued lithium treatment; in 37 patients the treatment had been discontinued. The lithium-treated patients were compared with a group of 68 manic-depressive patients who were about to be given prophylactic lithium treatment but who had not yet started. Neither the patients who continued nor the patients who had discontinued lithium showed any deterioration of glomerular filtration rate as assessed through determination of the 24-h creatinine clearance and the serum creatinine concentration; mean values in the lithium-treated patients were the same as mean values in patients not yet given lithium. Impairment of renal water reabsorption, revealed by increased 24-h urine volume and decreased urine osmolality after DDAVP, had progressed in the patients who continued lithium treatment, and multiple regression analysis revealed the duration of treatment and the serum lithium level to be significant predictor variables. In the patients who had discontinued lithium the changes in renal water handling had decreased. The urine volume was the same as that found in the patients not yet given lithium; maximum urine osmolality had not become fully normalized. Side effects such as thirst, nycturia, tremor, diarrhoea, oedema, and weight gain were found with the same frequency at the second as at the first examination in the patients who had continued lithium. In the patients who had discontinued lithium they were infrequent or absent.

Topics: Adult; Creatinine; Deamino Arginine Vasopressin; Diuresis; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Concentrating Ability; Kidney Diseases; Lithium; Middle Aged; Water

Renal concentration tests were carried out on 45 healthy volunteers and 106 patients with chronic renal disease of moderate degree involving impaired concentrating ability. Each subject served as his own control. The control experiment involved a total of 36 hr of "dehydration" (no fluids per os or food with a high fluid content such as fruit) in which 4 hr clearance periods were started from the 12th and continued to thd 36th hr. The first 12 hr involved an overnight period from 20.00 hr. One week later the same subjects were given 10 micrograms demopressin (dDAVP) at the 13th hr and a subsequent 4 hr clearance period provided blood and urine samples to compare desmopressin-induced urine concentration with various stages of concentration during oral fluid withdrawal alone. The drug was given intranasally. We measured urine osmolality and concentrations of urea. Na, K and calculated the U/P creatinine concentration ratios and creatinine clearances (CCr). Using Uosm as the criterion, the dDAVP experiment at 12 hr gave the same results as 24 hr of fluid withdrawal alone. With the U/PCr ratio as the criterion, dDAVP + 12 hr gave the same results as 36 hr of fluid withdrawal alone. Between 32 and 36 hr dehydration, CCr decreased - otherwise it remained unchanged in both healthy and ill subjects, with and without dDAVP. The only side-effect was the discomfort of more than 12 hr dehydration. This would appear to simplify a potentially useful diagnostic and prognostic test.

Topics: Adolescent; Adult; Aged; Arginine Vasopressin; Chronic Disease; Creatinine; Deamino Arginine Vasopressin; Electrolytes; Female; Humans; Kidney Concentrating Ability; Kidney Diseases; Kidney Function Tests; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Humans; Kidney Concentrating Ability; Kidney Diseases; Male; Methods; Middle Aged

Topics: Adolescent; Adult; Brain Injuries; Brain Neoplasms; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Kidney Diseases; Male; Vasopressins

Topics: Arginine Vasopressin; Blood; Deamino Arginine Vasopressin; Kidney Diseases; Renal Insufficiency, Chronic; Vasopressins