pituitrin and Anuria

Topics: Anesthesia; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Spinal; Anesthetics; Angiotensin II; Animals; Anuria; Glomerular Filtration Rate; Hemodynamics; Humans; Hypotension; Hypoxia; Kidney; Kidney Function Tests; Preanesthetic Medication; Regional Blood Flow; Renin; Shock, Hemorrhagic; Vasopressins; Water-Electrolyte Balance

The purpose of this study was to confirm earlier reports that low-dose vasopressin (LDVP) analogues promote urine output in patients with hepatorenal syndrome (HRS) and to check whether this mode of therapy could also be effective in renal shutdown due to nonhepatic conditions.. A prospective, open, interventional study.. An intermediate-level (step-down) medical intensive care unit within a general medical ward of a large university-affiliated hospital.. Eighteen successive hospitalized patients with HRS (mean age 65 +/- 13 years) and 11 patients with end-stage congestive heart failure (CHF) (mean age 81 +/- 5 years) who failed to restore urine output with conventional treatment (fluids, dopamine, and diuretics) given for at least 24 h.. The patients received LDVP (1 IU h-1) continuously in addition to the conventional treatment.. Urine output and creatinine clearance every 24 h.. In the HRS group, before treatment the urine output was 155 +/- 9 mL 24 -1h (mean +/- SD). After treatment with LDVP for 24, 48, and 72 h, urine output improved to 1067 +/- 87, 1020 +/- 501, and 1311 +/- 988 mL 24 -1h, respectively (P < 0.0001 for all measures; two-tailed paired t-test). In the CHF group, before treatment the urine output was 99 +/- 99 mL 24 -1h. After treatment with LDVP for 24, 48, and 72 h, this improved to 1125 +/- 994 mL 24 -1h (P = 0.0028), 1821 +/- 1300 mL 24 -1h (P = 0.004), and 2920 +/- 2423 mL 24 -1h (P = 0.0012), respectively. The improvement in urine output was not accompanied by a parallel improvement in creatinine clearance. The overall outcome did not change, and all patients except two in each group succumbed to their end-stage disease, due to nonrenal causes.. LDVP is effective in restoring urine output both in HRS and in CHF. This suggests that LDVP affects mechanisms not specifically related to liver disease. LDVP may be useful in critical patients with renal shutdown whilst awaiting liver or heart transplantation.

Topics: Aged; Aged, 80 and over; Anuria; Creatinine; Diuresis; Drug Administration Schedule; Female; Heart Failure; Hepatorenal Syndrome; Humans; Male; Middle Aged; Prospective Studies; Renal Agents; Treatment Outcome; Vasopressins

We present the investigation and management of a premature, hypotensive neonate born after a pregnancy complicated by anhydramnios to highlight the impact of early and informed management for rare kidney disease. Vasopressin was used to successfully treat refractory hypotension and anuria in the neonate born at 27 weeks of gestation. Next generation sequencing of a targeted panel of genes was then performed in the neonate and parents. Subsequently, two compound heterozygous deletions leading to frameshift mutations were identified in the angiotensin 1-converting enzyme gene ACE; exon 5:c.820_821delAG (p.Arg274Glyfs*117) and exon24: c.3521delG (p.Gly1174Alafs*12), consistent with a diagnosis of renal tubular dysgenesis. In light of the molecular diagnosis, identification, and treatment of associated low aldosterone level resulted in further improvement in renal function and only mild residual chronic renal failure is present at 14 months of age. Truncating alterations in ACE most often result in fetal demise during gestation or in the first days of life and typically as a result of the Potter sequence. The premature delivery, and serendipitous early treatment with vasopressin, and then later fludrocortisone, resulted in an optimal outcome in an otherwise lethal condition.

Topics: Adult; Anuria; Base Sequence; Female; Fludrocortisone; Frameshift Mutation; Gene Deletion; High-Throughput Nucleotide Sequencing; Humans; Hypotension; Infant, Newborn; Infant, Premature; Kidney Tubules, Proximal; Molecular Sequence Data; Peptidyl-Dipeptidase A; Pregnancy; Treatment Outcome; Urogenital Abnormalities; Vasopressins

Oliguria is common in critically ill patients and may result from prerenal, renal, and postrenal causes. Oliguria also frequently develops in patients with normal concentrations of blood urea nitrogen and creatinine. Most of these patients do not develop renal failure. The authors prospectively studied 100 patients admitted to the ICU to determine the etiology of oliguria in these patients. Eighteen patients (18%) developed oliguria (less than 0.33 ml.kg-1.h-1 X 2 h). Seven and eleven patients were felt on clinical assessment to be hypovolemic or normovolemic, respectively. Compared with the hypovolemic patients, the normovolemic oliguric patients had significantly lower serum osmolalities (278 +/- 3 vs. 290 +/- 5 mOsm/kg H2O) and serum sodium concentrations (138 +/- 3 vs. 132 +/- 1 mEq/l). In addition, normovolemic patients had significantly higher urine sodium concentrations (83 +/- 12 vs. 13 +/- 2 mEq/l), fractional excretion of sodium (1.14 +/- 0.2 vs. 0.15 +/- 0.03), and renal failure indices (1.5 +/- 0.3 vs. 0.21 +/- 0.04). ADH concentrations in six hypovolemic and six normovolemic patients were increased in both groups but not significantly different. The hypovolemic patients increased their urine output from 17 +/- 2 ml/h to greater than 0.5 ml.kg-1.h-1 following a 500-ml bolus of normal saline. The normovolemic oliguric patients remained oliguric following the saline bolus (13 +/- 2 to 19 +/- 3 ml/h). The authors conclude that oliguria is common in critically ill patients and results from renal hypoperfusion and ADH excess.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anuria; Blood Volume; Diuresis; Furosemide; Humans; Inappropriate ADH Syndrome; Kidney; Oliguria; Osmolar Concentration; Reference Values; Sodium Chloride; Vasopressins

Topics: Anuria; Humans; Kidney; Oliguria; Vasopressins

Acute cerebral compression by a supra- and infratentorial balloon produced a triphasic pattern of diuresis. The 1st phase was characterized by polyuria associated with five fold increase of plasma (p) antidiuretic hormone (ADH) concentration, decreased urine osmolality in spite of natriuresis and blood pressure elevation. The 2nd phase was characterized by oliguria, a decrease of pADH and reduced urine Na+ concentration, whereas urine osmolality transiently increased. At this stage there was respiratory arrest and fall of blood pressure. The final stage was diabetes insipidus (DI), when EEG activity had disappeared. An increase of serum osmolality mainly occurred during the last DI phase. Serum Na+ concentration fluctuated slightly during the whole period of diuresis. These results present evidence, that the diuresis pattern reflects the hypothalamo-hypophyseal antidiuretic system (HHAS) reaction to acute intracranial pressure (ICP) increase with the vegetative symptoms of cerebral shock.

Topics: Animals; Anuria; Cats; Diabetes Insipidus; Hypothalamo-Hypophyseal System; Oliguria; Osmolar Concentration; Polyuria; Pseudotumor Cerebri; Vasopressins; Water-Electrolyte Balance

Decreased free water excretion and the development of interstitial edema are recognized characteristics of preeclampsia. However, the pathophysiology of decreased urine excretion in preeclampsia is presently controversial: diminished glomerular filtration, renal arteriolar spasm, elevated plasma vasopressin levels, and plasma volume contraction have been suggested as etiologies. We studied seven pregnant patients with a diagnosis of mild preeclampsia to assess the role of vasopressin, serum protein, and glomerular function in the renal excretion of water. The ability to excrete a water load was significantly and directly correlated with serum albumin (P less than 0.05) and protein (P less than 0.02) concentrations. Neither plasma vasopressin nor creatinine clearance correlated with water excretion. The similarity of preeclampsia and the nephrotic syndrome with regard to the renal excretion of water is discussed.

Topics: Anuria; Edema; Female; Glomerular Filtration Rate; Humans; Nephrotic Syndrome; Oliguria; Pre-Eclampsia; Pregnancy; Vasopressins; Water

Topics: Anuria; Diabetes Insipidus; Edema; Humans; Inappropriate ADH Syndrome; Oliguria; Syndrome; Vasopressins; Water-Electrolyte Balance

The importance and differential diagnosis of postoperative oliguria are discussed. A plea is made for the recognition of undesired postoperative antidiuretic hormone (ADH) secretion as a separate entity in the aetiology of postoperative oliguria. Five patients are described who suffered from postoperative oliguria and in whom the diagnosis of undesired ADH secretion was made. The successful treatment of this condition with diphenylhydantoin is emphasized.

Topics: Adult; Aged; Anuria; Diagnosis, Differential; Furosemide; Humans; Middle Aged; Oliguria; Osmolar Concentration; Postoperative Complications; Vasopressins

Topics: Acute Disease; Anuria; Child; Craniopharyngioma; Depression, Chemical; Diabetes Insipidus; Female; Humans; Injections, Intravenous; Phenytoin; Pituitary Neoplasms; Postoperative Care; Postoperative Complications; Secretory Rate; Sodium; Stimulation, Chemical; Time Factors; Vasopressins

Topics: Acute Kidney Injury; Aldosterone; Animals; Anuria; Burns; Diabetes Insipidus; Disease Models, Animal; Diuresis; Diuretics; Furosemide; Kidney; Male; Mineralocorticoid Receptor Antagonists; Rats; Shock, Traumatic; Sodium; Sodium Chloride; Time Factors; Urea; Vasopressins; Water

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Anuria; Body Weight; Child; Child, Preschool; Creatinine; Diuresis; Female; Glomerular Filtration Rate; Humans; Kidney Concentrating Ability; Male; Middle Aged; Natriuresis; Nephrons; Osmolar Concentration; Vasopressins; Water-Electrolyte Balance

Topics: Aged; Angiography; Anuria; Diabetes Insipidus; Diatrizoate; Female; Glucose; Humans; Kidney; Kidney Cortex; Kidney Medulla; Mannitol; Osmolar Concentration; Uremia; Urine; Vasopressins

Topics: Animals; Anuria; Autonomic Nervous System; Blood Pressure; Dogs; Female; Kidney; Male; Mannitol; Parabiosis; Pituitary Gland; Pressure; Reflex; Specific Gravity; Urinary Bladder; Urination; Urine; Vasopressins

Topics: Anesthesia, General; Animals; Anuria; Blood; Blood Pressure; Diuresis; Electric Stimulation; Epinephrine; Ethanol; Female; Kinetics; Male; Osmolar Concentration; Physical Stimulation; Polyuria; Potassium; Rabbits; Sodium; Stomach; Urethane; Urine; Vagotomy; Vagus Nerve; Vasopressins

Topics: Adult; Anuria; Female; Humans; Nephrosis; Pre-Eclampsia; Pregnancy; Vasopressins

Topics: Animals; Anuria; Diabetes Insipidus; Diuresis; Histological Techniques; Kidney; Microscopy, Electron; Osmolar Concentration; Perfusion; Rats; Urine; Vasopressins

Topics: Anuria; Blood Volume; Chemoreceptor Cells; Diuretics; Homeostasis; Humans; Kidney; Positive-Pressure Respiration; Pressoreceptors; Vasopressins

Topics: Animals; Anuria; Atrial Function; Blood Volume; Carbon Dioxide; Cardiac Output; Diuresis; Dogs; Female; Oxygen; Pituitary Gland, Posterior; Positive-Pressure Respiration; Pressoreceptors; Pulmonary Circulation; Time Factors; Vagotomy; Vasopressins

Topics: Aldosterone; Anemia; Anuria; Child; Child, Preschool; Diuresis; Diuretics; Glomerulonephritis; Humans; Infant; Kidney; Kidney Concentrating Ability; Kidney Diseases; Osmolar Concentration; Osmotic Pressure; Polyuria; Pyelonephritis; Thalassemia; Vasopressins; Water; Water-Electrolyte Balance

Topics: Anuria; Diuresis; Edema; Female; Humans; Kidney Tubules; Middle Aged; Vasopressins

Topics: Animals; Anuria; Blood Pressure; Diuresis; Mannitol; Mesenteric Arteries; Mesenteric Veins; Muscle Spindles; Osmolar Concentration; Portal Vein; Rats; Vasopressins

Topics: Acute Disease; Aldosterone; Angiotensin II; Animals; Anuria; Dogs; Glomerular Filtration Rate; Hypertension, Renal; Kidney; Liver Cirrhosis; Male; Organ Size; Renal Veins; Renin; Sodium; Vasopressins

Topics: Animals; Anuria; Dogs; Pituitary Gland, Posterior; Vasopressins; Water-Electrolyte Balance

Topics: Aminohippuric Acids; Animals; Anuria; Diuresis; Female; Glomerular Filtration Rate; Haplorhini; Inulin; Kidney; Male; Mannitol; Sodium; Vasopressins

Topics: Animals; Anuria; Coronary Disease; Denervation; Diuresis; Dogs; Hypophysectomy; Kidney; Methods; Parabiosis; Pituitary Gland, Posterior; Vasopressins

Topics: Adult; Anuria; Endocrine System Diseases; Female; Humans; Hypothalamo-Hypophyseal System; Thirst; Vasopressins

Topics: Adrenal Cortex Hormones; Adrenal Glands; Adrenocorticotropic Hormone; Animals; Anuria; Diabetes Insipidus; Hypophysectomy; Hypothalamo-Hypophyseal System; Hypothalamus; Pituitary Gland; Pituitary-Adrenal System; Polyuria; Rats; Stress, Physiological; Tissue Extracts; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex Hormones; Adrenal Glands; Anuria; Blood Circulation; Blood Glucose; Cortisone; Desoxycorticosterone; Humans; Insulin; Intestinal Obstruction; Mortality; Pituitary Gland, Posterior; Secretory Rate; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Anuria; Chlorpromazine; Diabetes Insipidus; Ethanol; Female; Humans; Hyponatremia; Male; Neurosecretion; Osmosis; Sensory Receptor Cells; Vasopressins

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Anuria; Glucose Tolerance Test; Humans; Middle Aged; Peritoneal Dialysis; Uremia; Vasopressins

Topics: Anuria; Biomedical Research; Blood Chemical Analysis; Humans; Osmosis; Potassium; Sodium; Stress, Physiological; Surgical Procedures, Operative; Vasopressins; Water-Electrolyte Balance

Topics: Anuria; Biomedical Research; Blood Chemical Analysis; Humans; Osmosis; Potassium; Sodium; Stress, Physiological; Surgical Procedures, Operative; Vasopressins; Water-Electrolyte Balance

Topics: Anuria; Arginine Vasopressin; Blood; Busulfan; Chromatography; Colorimetry; Fluids and Secretions; Glucose; Hypertonic Solutions; Mannitol; Metabolism; Neoplasms; Pharmacology; Rats; Research; Sodium Chloride; Sorbitol; Triethylenemelamine; Urine; Vasopressins

Topics: Anuria; Arginine Vasopressin; Humans; Obesity; Oliguria; Vasopressins