pituitrin and Oliguria

Topics: Aldosterone; Atrial Natriuretic Factor; Body Water; Dehydration; Fluid Therapy; Humans; Oliguria; Osmotic Pressure; Renin; Sodium; Vasopressins

Patients undergoing surgery for idiopathic scoliosis were studied to determine the incidence and aetiology of oliguria during the perioperative period and to evaluate the efficacy of low dose dopamine in preventing its occurrence. Thirty patients, aged 6-18 years undergoing elective surgery were studied. Anaesthesia was standardized. Patients were randomized to receive either dopamine infusion (3 micrograms.kg-1.min-1) (Group A) (n = 15) or dextrose infusion (control) (Group B) (n = 15). Serum and urinary electrolytes and osmolalities and serum antidiuretic hormone (ADH) concentrations were measured. Urine output and haemodynamic parameters were recorded. Intraoperative oliguria occurred in 7% of patients in Group A and 47% in Group B (P < 0.05). Postoperative oliguria occurred in 20% of patients in Group A and 47% in Group B (P > 0.05). Urine and serum biochemical analysis revealed a statistically significant decrease in serum sodium and osmolality (P < 0.005) and an increase in urinary sodium and osmolality in both groups. Serum ADH concentrations were increased in both groups (P < 0.05), returning to baseline 18 h postoperatively. We conclude that oliguria during corrective spinal surgery occurs in association with excess ADH secretion as opposed to perioperative hypovolaemia. Dopamine increases urine output in the perioperative period but does not prevent the release of ADH and its subsequent biochemical effects.

Topics: Adolescent; Anesthesia, Inhalation; Cardiac Output; Central Venous Pressure; Child; Diuresis; Dopamine; Female; Humans; Intraoperative Complications; Male; Oliguria; Osmolar Concentration; Postoperative Period; Scoliosis; Sodium; Spine; Vasopressins

We examined the link between increased intra-abdominal pressure, intracranial pressure, and vasopressin release as a potential mechanism. Intra-abdominal pressure, produced by abdominal-cavity insufflation with carbon dioxide (CO. Statistically significant elevations (all P ≤ .001) were noted from T. Increased mean arterial pressure, intracranial pressure, and vasopressin release appear to be intermediary steps between increased intra-abdominal pressure and oliguria. Further research is necessary to determine any causative links between these physiological changes.

Topics: Adult; Aged; Female; Gastrectomy; Humans; Intra-Abdominal Hypertension; Intracranial Hypertension; Laparoscopy; Male; Middle Aged; Oliguria; Pneumoperitoneum, Artificial; Prospective Studies; Vasomotor System; Vasopressins; Young Adult

This study was undertaken to investigate the role played by antidiuretic hormone (ADH), the renin-angiotensin system and atrial natriuretic factor (ANF) in the oliguria in patients undergoing spinal fusion.. Sixteen patients undergoing posterior spinal fusion using isoflurane and fentanyl (n = 8) or sufentanil (n = 8) had renin, aldosterone, ADH and ANF measurements.. Compared to the non-oliguric patients, the oliguric patients had a higher number of fused vertebrae 10.5 +/- 1.3 vs. 9.0 +/- 0.5 (P = 0.01) and higher renin values at 12h (3.3 +/- 3.2 vs. 0.7 +/- 0.6 ng L(-1) s(-1), P = 0.04). Hormonal values that had a significant correlation with intraoperative diuresis were: renin at 0.5 h (r2 = 0.26, P = 0.04), aldosterone at 0.5 h (r2 = 0.30, P = 0.03) and ANF at 0.5 h (r2 = 0.32, P = 0.02). Those that had a significant correlation with the mean postoperative diuresis were: renin at 6 h (r2 = 0.29, P = 0.03), 8h (r2 = 0.26, P = 0.04) and 12h (r2 = 0.31, P = 0.03), aldosterone at 6h (r2 = 0.54, P = 0.001), 8h (r2 = 0.40, P = 0.01) and 12h (r2 = 0.32, P = 0.03), ADH at 24h (r2 = 0.38, P = 0.01) and ANF at 6h (r2 = 0.26, P = 0.045). Using stepwise regression, excluding hormonal values, only two continuous variables had a significant correlation with the mean postoperative diuresis: the number of fused vertebrae (P = 0.02) and the length of surgery (P = 0.02).. Activation of the renin-angiotensin system is the major cause of the early intraoperative oliguria. ADH and the renin-angiotensin system are both involved in the pathophysiology of postoperative oliguria in patients undergoing spinal fusion.

Topics: Adolescent; Aldosterone; Anesthetics, Inhalation; Anesthetics, Intravenous; Atrial Natriuretic Factor; Female; Fentanyl; Humans; Isoflurane; Male; Oliguria; Renin; Renin-Angiotensin System; Scoliosis; Spinal Fusion; Sufentanil; Vasopressins

Topics: Anti-Bacterial Agents; Cervical Vertebrae; Demeclocycline; Fluid Therapy; Humans; Oliguria; Respiratory Distress Syndrome; Spinal Cord Injuries; 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

When comparing iatrogenic inhibition with endogenous stimulation of renal prostaglandin production, the role of this mediator and modulator system for renal function becomes apparent. Renal perfusion and glomerular filtration as well as modulation of tubular function with respect to electrolyte and water excretion is significantly influenced by renal prostaglandin activity. Treatment with the prostaglandin cyclooxygenase inhibitor indomethacin reduces the endogenous creatinine clearance by about fifty percent in a state of a diminished circulatory blood volume, such as may exist during left-to-right shunting across a persistent ductus arteriosus in preterm infants. In addition, urinary electrolyte and water excretion is reduced by increased tubular absorption leading to marked oliguria. In contrast, electrolytes and water are lost in congenital renal tubular disorders associated with increased prostaglandin E2 (PGE2) activity (a so called hyperprostaglandin E syndrome). Patients with this renal disorder require a permanent high dosed indomethacin therapy. After this pharmacotherapy has brought electrolyte and water metabolism into balance, no deterioration of glomerular filtration and renal perfusion was observed. This is in accordance with the general principle that renal function only becomes dependent on the vasodilatory activity of renal prostaglandins in a stress situation resulting in the threat of hypoperfusion. It is essential to bear in mind the physiological and pathophysiological role of renal prostaglandins, when prescribing frequently administered prostaglandin cyclooxygenase inhibitors like aspirin, paracetamol or indomethacin in pediatrics. Otherwise, renal function may deteriorate or the kidney will be irreversibly damaged.

Topics: Angiotensin II; Aspirin; Child, Preschool; Creatinine; Ductus Arteriosus, Patent; Glomerular Filtration Rate; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Kidney Function Tests; Oliguria; Prostaglandins; Prostaglandins E; Renal Circulation; Renin-Angiotensin System; Vasopressins; Water-Electrolyte Balance

A basal value of antidiuretic activity (ADA) of the plasma was determined in 79 HFRS patients and stimulated activity using the insulin tolerance test in 24 persons. A decrease in the plasma ADA was observed in the acute period of disease. The insulin tolerance test did not cause a statistically significant increment of the plasma ADA in the HFRS patients.

Topics: Adolescent; Adult; Convalescence; Hemorrhagic Fever with Renal Syndrome; Humans; Hypothalamo-Hypophyseal System; Insulin; Middle Aged; Oliguria; Polyuria; Time Factors; Vasopressins

The role of blood volume regulatory mechanisms located in the low pressure system in the control of urinary excretion was studied using hypobaric pressure breathing in normal and diabetes insipidus (Brattleboro strain with a congenital lack of vasopressin) rats. Rats were placed in an altitude simulator chamber for 4 h. A pump maintained pressure reduced to 701, 577 and 472 mbar simulating respectively altitude of 3,000, 4,500 and 6,000 m. In normal rats, hypobaric breathing induced an increase in urine flow, urinary urea and K+ excretion and urinary pH but did not significantly modify creatinine and Na+ excretion. In diabetes insipidus rats, hypobaric breathing produced oliguria and an decrease in urea, creatinine, Na+, K+, Cl- urinary excretions. Since acute hypobaric pressure breathing induced opposed effects in normal and Brattleboro rats, it is suggested that this kind of experimental procedure which increases intrathoracic blood volume elicits a diuretic response through an inhibition of vasopressin release. These experiments confirm the main role of vasopressin in the control of central blood volume.

Topics: Air Pressure; Animals; Atmospheric Pressure; Blood Volume; Chlorine; Diabetes Insipidus; Disease Models, Animal; Diuresis; Male; Natriuresis; Oliguria; Pituitary Gland, Posterior; Potassium; Rats; Rats, Inbred Strains; Urea; Vasopressins

Perioperative plasma antidiuretic hormone (vasopressin) levels were determined in 8 patients undergoing radical cystectomy. Marked elevations of antidiuretic hormone were noted immediately postoperatively in all patients and these levels persisted for 48 hours. Plasma antidiuretic hormone was elevated beyond the physiological levels needed for maintenance of intravascular volume and osmolarity. Excessive antidiuretic hormone secretion is common after radical cystectomy and should be considered in the differential diagnosis of postoperative oliguria in these patients.

Topics: Aged; Diagnosis, Differential; Female; Furosemide; Humans; Ileum; Male; Middle Aged; Oliguria; Osmolar Concentration; Postoperative Complications; Postoperative Period; Time Factors; Urinary Bladder; Urinary Diversion; Vasopressins

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

Adverse renal reaction during prolonged indomethacin therapy (1 week) was studied in 15 preterm infants with persistent ductus arteriosus (PDA), which was associated with an ineffective circulatory volume. Following the medication a decrease in diuresis and creatinine clearances together with an increase in urinary osmolality and body weight was observed. Determinations of selected vasoactive hormones, such as plasma renin activity (PRA), antidiuretic hormone (ADH), and renal and systemic prostaglandins, indicated a complex pathophysiological condition of renal hypoperfusion and antidiuretic excess. During the treatment with indomethacin an effective circulatory volume had been restored by closing the ductus, which was followed by hormonal normalization. Subsequently kidney function was recovering despite continued indomethacin therapy. Based on these observations, one may assume that prolonged indomethacin therapy for prevention of PDA relapses is probably of no further harm to kidney function once the ductus has been closed successfully.

Topics: Blood Volume; Body Weight; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Kidney; Kidney Function Tests; Oliguria; Osmolar Concentration; Prostaglandins; Renin; Time Factors; Vasopressins

Topics: Acute Kidney Injury; Angiotensin II; Humans; Ischemia; Kidney; Kidney Tubular Necrosis, Acute; Kidney Tubules; Oliguria; Prostaglandins; Renin; Vasopressins

Topics: Animals; Dogs; Female; Male; Oliguria; Urinary Bladder; Urine; Vasopressins

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

Topics: Fluid Therapy; Humans; Oliguria; Surgical Procedures, Operative; Vasopressins

Rational intraoperative fluid therapy is based on an understanding of the pathophysiology of severe trauma and surgery. Fluids of suitable compositions are administered in sufficient quantities to form part of the daily maintenance requirement and also to replace blood and ECF lost during surgery.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Blood Transfusion; Extracellular Space; Humans; Infusions, Parenteral; Kallikreins; Kidney; Oliguria; Postoperative Complications; Renin; Shock; Sodium; Surgical Procedures, Operative; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Anesthesia; Animals; Dogs; Ethyl Ethers; Female; Fentanyl; Halothane; Humans; Kidney; Male; Middle Aged; Oliguria; Osmolar Concentration; Surgical Procedures, Operative; Thiopental; Urine; Vasopressins

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: Animals; Diabetes Insipidus; Disease Models, Animal; Drinking; Drinking Behavior; Female; Food Deprivation; Hypothalamus; Hypothalamus, Middle; Hypothalamus, Posterior; Kidney Concentrating Ability; Kidney Function Tests; Male; Natriuresis; Oliguria; Pituitary Gland, Posterior; Rats; Vasopressins

In this investigation, are studied in rabbits, the effects of gastric distention upon plasma concentration of vasopressin; the arginine-vasopressine is determined by a very sensitive radio-immunologic method. Increases of intragastric ballonet pressure up to 10-20 cmH2O induce significant rise in plasma vasopressin concentrations averaging 21 +/- 3,7 muU/ml (base line 6,25 +/- 2,3 muU/ml). Increase of vasopressin is associated with significantly lowered diuresis. Intravenous injections of nicotine induce similar decrease in urine flow and increase of plasma AVP concentrations up to 12,01 +/- 1,7 muU/ml.

Topics: Animals; Blood Pressure; Diuresis; Female; Male; Oliguria; Rabbits; Radioimmunoassay; Reflex; Stomach; Vasopressins; Venous Pressure

Topics: Adult; Aged; Antigen-Antibody Reactions; Circadian Rhythm; Colonic Neoplasms; Diuresis; Homeostasis; Humans; Lymph Node Excision; Middle Aged; Oliguria; Osmolar Concentration; Plasma; Postoperative Care; Preoperative Care; Radioimmunoassay; Splenectomy; Surgical Procedures, Operative; Urine; Vasopressins; Water-Electrolyte Balance

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