digoxin and Proteinuria

Takayasu arteritis is a systemic vasulitis of large vessels that mainly involves the aorta and its branches. It normally presents in third decade of life and has rarely been reported in children under 10 years of age. We report here a case of Takayasu arteritis in a 5 years old girl who presented with headache, generalized body swelling, severe hypertension, proteinuria and minimal functioning kidneys. Conventional angiography demonstrated narrowing of descending aorta, right subclavian artery and right common iliac artery. She responded steroids, diuretics, antiplatelets and digoxin and discharged home on maintenance therapy.

Topics: Aorta, Thoracic; Cardiotonic Agents; Child; Coronary Angiography; Digoxin; Diuretics; Female; Headache; Humans; Hypertension; Platelet Aggregation Inhibitors; Proteinuria; Subclavian Steal Syndrome; Takayasu Arteritis; Treatment Outcome

In a population-based study in southern Wisconsin, 1370 diabetic persons diagnosed after 29 years of age were examined using standard protocols to determine the prevalence of proteinuria and associated risk variables. Proteinuria (greater than or equal to 0.30 g/L) was present in 18.0% of persons taking insulin and 12.2% of the persons not taking insulin. Proliferative retinopathy and proteinuria were associated with each other. Proteinuria was also associated with increasing duration of diabetes, high systolic blood pressure, use of digoxin, and being male, but not with a history of cigarette smoking or metabolic control as measured by glycosylated hemoglobin.

Topics: Adult; Age Factors; Aged; Diabetes Complications; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Digoxin; Female; Humans; Hypertension; Male; Middle Aged; Proteinuria; Time Factors

Possible involvement of an endogenous digitalislike substance (EDLS) in blood pressure regulation was investigated using a Japanese population. Mean arterial pressure (MAP) significantly correlated with urinary excretion of the EDLS, age, and the obesity index. The plasma EDLS correlated with urinary EDLS. Urinary EDLS excretion well correlated with the inhibitory activity on Na+,K+-ATPase, and also with the urinary excretion of NaCl. Obesity index correlated with the Na+,K+-ATPase inhibition and arterial pressure. Although plasma content of atrial natriuretic polypeptide correlated with the urinary Na+,K+-ATPase inhibition, it did not correlate with the rest of all parameters. Plasma vasopressin level did not correlate with these parameters either. These results clearly indicate that the circulating EDLS (ie, Na+,K+-ATPase inhibitor) is implicated in the hypertension associated with an excess intake of sodium, aging and obesity.

Topics: Adult; Aged; ATPase Inhibitory Protein; Blood Pressure; Blood Proteins; Cardenolides; Digoxin; Female; Humans; Japan; Male; Middle Aged; Obesity; Proteins; Proteinuria; Saponins

Natriuretic and Na-K-ATPase inhibitory material prepared from urine by gel filtration on G25 Sephadex was previously found to be of low molecular weight, polar and non-peptide. Although activity appeared to depend on an amino group, tests and radioenzymatic assays for catecholamines suggested that these were not implicated in the natriuretic activity. Further purification of the material included solvent extraction, cation exchange and high performance liquid chromatography. At each stage, fractions were assayed for natriuretic activity, stimulation of G6PD and inhibition of Na-K-ATPase in cytochemical assays, and for digoxin-like activities i.e. inhibition of dog kidney Na-K-ATPase (Sigma), displacement of 3H ouabain bound to cell membranes and cross reaction with antidigoxin antibody. The crude material possessed all activities, but with successive purifications the activities separated from each other and were thus due to different substances. Analyses for catecholamines with HPLC and electrochemical detection revealed that the natriuretic activity was due to dopamine.

Topics: ATPase Inhibitory Protein; Chromatography, Gel; Chromatography, High Pressure Liquid; Cross Reactions; Digoxin; Glucosephosphate Dehydrogenase; Humans; Molecular Weight; Natriuretic Agents; Ouabain; Proteins; Proteinuria; Sodium-Potassium-Exchanging ATPase

Previous investigations have demonstrated an increased amount of a sodium pump inhibitor (N.H.) in plasma from humans with essential hypertension and from animals with various forms of experimental hypertension. The present study has employed Sephadex column and C18 reverse phase separation of urines from patients with essential hypertension and normal controls to distinguish "high", "intermediate" and "low" molecular weight forms of N.H., measured through properties of Na-K-ATPase inhibition and digoxin-like immunoreactivity. The major difference between hypertensive and normotensive urines was a highly significant increase in the "intermediate" molecular weight form of N.H., as measured by Na-K-ATPase inhibition. In contrast, digoxin-like immunoreactivity was significantly decreased in urine from hypertensive patients. The results are compatible with an hypothesis that the defect in some forms of essential hypertension may be partial inhibition of enzymatic conversion of intermediate to final form of N.H., with the increased sodium pump inhibition primarily related to the precursor.

Topics: ATPase Inhibitory Protein; Chromatography, Gel; Chromatography, High Pressure Liquid; Digoxin; Humans; Hypertension; Models, Biological; Molecular Weight; Proteins; Proteinuria

In the present study natriuretic activity and digoxin-like immunoreacting activity (DLIA) were determined in small molecular weight (MW) fractions of urine from healthy subjects during low (35 mmol/day) and high (greater than 400 mmol/day) sodium intake by bioassay and by a radioimmunoassay for digoxin, respectively. After gel filtration of urine on a Sephadex G-25 column the natriuretic activity appeared in the post-salt fraction SIV, whereas DLIA was present in small amounts in the salt fraction SIII and, with consistently higher activity, in the post-salt fraction SIV. Natriuretic activity significantly increased and DLIA decreased in fraction SIV with high sodium intake, but total urinary excretion of DLIA remained unaltered during changes in sodium intake. In addition, anion-exchange and reverse-phase chromatography revealed that DLIA is not specifically related to the natriuretic activity but also reflects unspecific binding of various urine constituents to this digoxin antibody. Although the antibody binds a natriuretic material, this radioimmunoassay is thus unsuitable to determine the endogenous natriuretic activity in urine fractions. Whereas they elute differently on reverse-phase chromatography, amino acid analyses revealed that both the natriuretic factor directly purified from the post-salt fraction SIV and the natriuretic material bound to the digoxin antibody have in common four amino acids at similar molar ratios. The physicochemical properties as evidenced by chromatographic and electrophoretic studies as well as enzymatic inactivation suggest that the low MW natriuretic factor(s) in human urine may be associated with a small peptide(s) of weak acidic nature.

Topics: Adult; Animals; Antibodies; Biological Assay; Chromatography, Gel; Chromatography, Ion Exchange; Diet, Sodium-Restricted; Digoxin; Female; Humans; Male; Natriuresis; Natriuretic Agents; Precipitin Tests; Proteinuria; Radioimmunoassay; Rats; Sodium Chloride; Time Factors