OBJECTIVE: To evaluate the renal function by investigating the relationship among serum cystatin C, serum creatinine, creatinine clearance and the average of bilateral ERPF (effective renal plasma flow) ratio of the MAG3 renal scan for the spinal cord injured patients. METHOD: Seventy-one spinal cord injured patients who admitted to our department were evaluated from January 2004 to October 2004. Blood samples and 24-hour urine of all the subjects were collected for measuring serum cystatin C, serum creatinine and creatinine clearance. MAG3 renal scan was done for 47 subjects. Regression analysis and Pearson's correlation methods were utilized for statistical analysis. RESULTS: There was significant correlation between 1/cystatin C and creatinine clearance (p<0.001) and the correlation coefficient between 1/cystatin C vs. creatinine clearance (R= 0.552) was bigger than that between 1/creatinine and creatinine clearance (R=0.329). The reciprocal of cystatin C was positively correlated with the average of bilateral ERPF ratio of MAG3 renal scan (p=0.01), while there was no significant correlation between 1/creatinine and the average of bilateral ERPF ratio. CONCLUSION: Measurement of serum cystatin C is a useful and convenient method for the evaluation of renal function in spinal cord injured patients.
Creatinine ; Cystatin C* ; Humans ; Plasma ; Renal Plasma Flow, Effective ; Spinal Cord Injuries ; Spinal Cord*

OBJECTIVE: To analyze association between urodynamic study (UDS) parameters and renal function in spinal cord injured (SCI) patients with neurogenic detrusor overactivity. METHODS: Patients with a suprasacral SCI, who underwent UDS and radioisotope renogram at least twice between January 1, 2006 and January 31, 2013, were included. UDS (cystometric capacity, reflex volume, compliance, and maximal detrusor pressure) and radioisotope renogram (total effective renal plasma flow [ERPF] of both kidneys) data were collected. The following were conducted to reanalyze any association between reflex volume and ERPF: initial and follow-up results of consecutive evaluations were compared; a mixed-model regression analysis to account for clustered data was conducted to evaluate the association between UDS parameters and ERPF; and finally, a mixed-model analysis type 3 test with data pairs, of which the first evaluation showed involuntary detrusor contraction. RESULTS: A total of 150 patients underwent 390 evaluations which were arranged into 240 pairs of consecutive evaluations, of which 171 had first evaluations with observed involuntary detrusor contraction. The following results were obtained: cystometric capacity was significantly larger and maximal detrusor pressure was significantly lower on follow-up; on univariate analysis, reflex volume and maximal detrusor pressure were significant, and multivariate analysis using these two parameters showed that maximal detrusor pressure is significantly associated with total ERPF; and no significant differences were observed. CONCLUSION: Maximal detrusor pressure should be closely monitored in the urologic management of neurogenic detrusor overactivity in SCI patients. The results also may serve as a reference for regular UDS follow-up.
Compliance ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Reflex ; Renal Plasma Flow ; Renal Plasma Flow, Effective ; Spinal Cord ; Spinal Cord Injuries* ; Urinary Bladder, Neurogenic ; Urodynamics*

As an attempt to elucidate the functional changes of the transplanted kidney with particular emphasis on the immediate postoperative periods, various renal functions of the graft kidney were compared with that of the remaining normal kidney after auto and homotransplantation in the dog. The results are summarized briefly as follows: 1. Glomerular filtration rate(GFR) and renal plasma flow (RPF) of the graft kidney was approximately 50 to 60 per cent of the normal kidney immediately following operation both in auto and homotransplantation. 2. Fraction of filtered water and electrolytes excreted was significantly greater in graft kidney and seemed to be caused by transient tubular damage. 3. The maximum concentration ability of urine in the graft kidney was significantly reduced. 4. Transfer maxima for PAH secretion of the graft kidney was reduced proportionately as the reduction of renal plasma flow, thus not affecting the tubular perfusion ratio. 5. The magnitude of splay in the PAH titration curve was identical between control and graft kidney. These findings suggest that intrarenal distribution of the blood flow is not altered in the graft kidney immediately following operation.
Animals ; Attention ; Dogs ; Electrolytes ; Filtration ; Kidney Transplantation ; Kidney* ; Perfusion ; Postoperative Period ; Renal Plasma Flow ; Transplants* ; Water

It is generally known that the renal function is significantly decreased immediately after renal transplantation. However, there is no literature concerning the influence of vascular factor such as thrombus formation and narrowing of the vascular lumen due to its anastomosis on the renal functions following kidney transplantation. As an attempt to dissociate the effect of vascular factors from the immediate functional capacity after transplantation. the author studied the various renal function after clamping the renal artery and perfusing the kidney for 45 minutes while avoiding injury to the renal pedicle as much as possible. Then the recovery pattern of renal function was observed for 2 weeks. In every phase of the experiment (immediately, 1,3,7, and 14 days after the clamping and perfusion) various renal functions of the experimental kidney (left kidney) were compared with that of the normal kidney (right kidney). The results are summarized briefly as follows: 1. Hemodynamic changes such as glomerular filtration rate and renal plasma flow were decreased to approximately 65~75% of the control kidney by 7 days after the experiment and then recovered to the values of the normal kidney. 2. Tubular reabsorption of water and electrolytes were reduced in the experimental kidney until the 7th day after the procedures, but these decreases were improved to nearly normal 2 weeks after the renal artery clamping and perfusion. This reduction of tubular reabsorption capacity is considered to be brought by ischemia-induced tubular damage 3. The extraction ratio of PAH was significantly dropped to about 50% of the normal at 3 days after the experiment, then it recovered almost to normal at 14 days after the procedures. In addition total renal plasma flow calculated from C(pah)/E(pah) was almost identical in both kidneys except in the 3 days group which showed a significant increase in the experimental kidney. This finding suggested that postocclusive reactive hyperemia developed. 4. The above mentioned results showed that renal functions after renal artery clamping and perfusion of the kidney with cold (4 degrees C) solution were decreased significantly by the 7th followed with almost normal recovery 2 weeks after the experiment. It was suggested that the period of recovery of renal function was shortened by cold perfusion of the kidney, and day and vascular factors did not influence significantly on the decrease in renal functions after renal transplantation.
Animals ; Constriction ; Dogs* ; Electrolytes ; Glomerular Filtration Rate ; Hemodynamics ; Hyperemia ; Kidney Transplantation ; Kidney* ; Perfusion* ; Renal Artery ; Renal Plasma Flow ; Thrombosis ; Water

BACKGROUND: Vascular access failure, a major cause of morbidity in hemodialysis (HD) patients, occurs mainly at stenotic endothelium following an acute thrombotic event. Microparticles (MPs) are fragments derived from injured cell membrane and are closely associated with coagulation and vascular inflammatory responses. METHODS: We investigated the relationship between levels of circulating MPs and vascular access patency in HD patients. A total of 82 HD patients and 28 healthy patients were enrolled. We used flow cytometry to measure endothelial MPs (EMPs) identified by CD31+CD42- or CD51+ and platelet-derived MPs (PMPs) identified by CD31+CD42+ in plasma samples of participants. Vascular access patency was defined as an interval from the time of access formation to the time of first access stenosis in each patient. MP counts were compared according to access patent duration. RESULTS: The levels of EMP (both CD31+CD42- and CD51+) and CD31+CD42+PMP were significantly higher in patients than in healthy participants. Levels of CD31+CD42-EMP and CD31+CD42+PMP showed a positive correlation. In nondiabetic HD patients, CD31+CD42-EMPs and CD31+CD42+PMPs were more elevated in the shorter access survival group (access survival <1 year) than in the longer survival group (access survival > or = 4 years). CONCLUSION: Elevated circulating EMP or PMP counts are influenced by end-stage renal disease and increased levels of EMP and PMP may be associated with vascular access failure in HD patients.
Blood Platelets ; Cell Membrane ; Constriction, Pathologic ; Endothelial Cells ; Endothelium ; Flow Cytometry ; Humans ; Kidney Failure, Chronic ; Plasma ; Renal Dialysis

Arginine vasotocin has long been known as an antidiuretic hormone in non-mammalian vertebrates. The peptide has also been found in mammalian tissues. The physiological significance of the peptide, however, has not yet been clarified in mammals. To define the effect of arginine vasotocin on the water and electrolyte balance in mammalian vertebrates, experiments have been done. Intrarenal arterial infusion of arginine vasotocin, 0.01-10ng/kg/min resulted in dose-dependent decreases in urine volume and free water clearance and an increase in urinary osmolarity. Arginine vasotocin, in a dose of 0.03ng/kg/min, induced an increase in water reabsorption without changes in glomerular filtration rate. Intrarenal infusion of arginine vasotocin in doses ranging from 0.1 to 3.0 or 10.0ng/kg/min resulted in decreases in glomerular filtration rate and renal plasma flow. However, no dose dependence were observed. Intrarenal infusion of arginine vasotocin from 0.3 to 10 ng/kg/min induced dose-dependent natriuretic and kaliuretic effects with concomitant suppression of renin secretion. The renal effects of arginine vasotocin were blocked by arginine vasopressin V2-receptor antagonist [d(CH2)5, D-Phe2, Ile4, Ala9-NH2]-vasopressin but were not blocked by[d(CH2)5, D-Ile2, Ile4, Arg8]- vaso pression. These data suggest that the effect of arginine vasotocin on the renal function are similar to that of vasopressin in mammalian vertebrates. The data also suggest that the renal effects of arginine vasotocin may be coupled to the receptor system which is similar, if not identical, to that of arginine vasopressin.
Arginine Vasopressin ; Arginine* ; Glomerular Filtration Rate ; Mammals ; Osmolar Concentration ; Renal Plasma Flow ; Renin ; Vasopressins ; Vasotocin* ; Vertebrates ; Water ; Water-Electrolyte Balance

PURPOSE: Among renotropic agents, a growth hormone(GH) independent insulin-like growth factor I(IGF-I) improves renal function without inducing glomerulosclerosis and its potential for treating renal disease is increasing. To elucidate the effect of externally administered IGF-I toward enhancing renal function, the change in renal function and renal nitric oxide synthase(NOS) activity were investigated in the presence of the GH-IGF-I axis. MATERIALS AND METHODS: 100?150g Sprague-Dawley male rats were classified four groups according to experimental methods. The left kidney were removed in the rats of UNx group(uninephrectomy) and UNx+IGF-I group(IGF-I treated after uninephrectomy), and sham operation were done in the other rats of control group and Sham+IGF-I group(IGF-I treated after sham operation). The UNx+IGF-I group and Sham+IGF-I group were treated with 300microgram of recombinant IGF-I(rhIGF-I) daily for 5days after operation. The NOS activity were determined in the contralateral kidney tissues and the glomerular filtration rate(GFR) and effective renal plasma flow(ERPF) were determined in the serum. RESULTS: The GFR, ERPF and NOS activity significantly increased compared to control after uninephrectomy(p<0.05). The GFR, ERPF and NOS activity were significantly different between UNx+IGF-I group and UNx group(p<0.05), but there was no significant difference between Sham+IGF-I group and Sham group after the administration of rhIGF-I. CONCLUSIONS: Externally administered rhIGF-I increases GFR and ERPF via increasing NOS activity. We suggest that it is especially effective in improving the renal function of damaged kidneys.
Animals ; Axis, Cervical Vertebra ; Filtration ; Humans ; Hypertrophy* ; Insulin-Like Growth Factor I* ; Kidney* ; Male ; Nitric Oxide Synthase* ; Nitric Oxide* ; Plasma ; Rats ; Rats, Sprague-Dawley ; Renal Plasma Flow, Effective

It is well known that unilateral nephrectomy induces a series of morphological changes in the remaining kidney. These morphological changes called as "compensatory hypertrophy and hyperplasia" are associated with numerous functional changes of the remnant kidney, such as relative increase in the glomerular filtration rate and the renal plasma flow as well as changes in the renal concentrating ability. However, changes in the water and electrolytes excretion following unilateral nephrectomy have not been extensively studied. Hence, this investigation was undertaken to study the excretory pattern of water and electrolytes through the remaining kidney following unilateral nephrectomy. Experiments were carried out in 23 hydropenic dogs, weighing 10~16 kg, of which 5 dogs were used for acute experiments (4 hrs. after nephrectomy) and 18 dogs for chronic experiments (2 weeks, 4 weeks and 6 weeks after nephrectomy). Following intravenous administration of appropriate amounts of inulin and PAH, plasma and urine samples were obtained and were analyzed for the concentration of inulin, PAH, osmolarity, Na, K and urea. In chronic experiments, Animals were allowed to have free access to the food and water during intervals. Four slices of the tissue from papilla to cortex were cut for each kidney. The Na, K, Cl and urea concentrations of the slice were then determined in slice extracts. Also four slices of the kidney cortex were obtained and analyzed for concentration of PAH. Results may be briefly summarized as follows. 1. After unilateral nephrectomy, the weight of the remaining kidney increased about 30 percent in 2-6 Weeks. 2. During 1 hours after unilateral nephrectomy, the glomerular filtration rate (GFR) of the remaining kidney showed no significant changes while the renal plasma flow (RPF) decreased gradually to a level below the control. In chronic experiments, the GFR showed no change after the nephrectomy whereas the RPF showed a 20 percent increased, thus reducing the filtration fraction. 3. During 1 hours after unilateral nephrectomy, the urine osmolarity revealed no significant changes while the fractional excretion of the filtered osmotic substance, water, sodium and potassium were gradually increased, indicating relative impairments of the tubular reabsorption of these substances. 4. During 2.-,6 weeks after unilateral nephrectomy, the renal concentrating ability of the remaining kidney was significantly impaired. The fractional excretion of the filtered water was most markedly increased while the tubular reabsorption of urea was somewhat increased. 4. No significant changes in plasma composition was noted in all animals, indicating that the overall homeostatic mechanism is apparently well maintained even after unilateral nephrectomy, 6. PAH concentration in the slices of renal cortex after unilateral nephrectomy were markedly increased, suggesting that the increase of PAH uptake on the renal cortex is partially attributable to a increase of the tubular mass of remaining kidney. 7. Medullary and papillary Na and Cl concentration was somewhat lower in the chronic experiments, indicating that the renal concenting operation is impaired in unilateral nephrectomized kidney primarily because of corresponding reduction in the medullary osmotic gradient. However, total papillary osmotic concentration at a given urine osmolarity was no significantly changed in before and after unilateral nephrectomy.
Administration, Intravenous ; Animals ; Dogs ; Electrolytes ; Filtration ; Glomerular Filtration Rate ; Hypertrophy ; Inulin ; Kidney ; Kidney Cortex ; Nephrectomy* ; Osmolar Concentration ; Plasma ; Potassium ; Renal Plasma Flow ; Sodium ; Urea ; Water

OBJECTIVE: The purposes of this study were to determine the renal function by radioisotope renography and to compare the findings of radioisotope renography in the spinal cord injured patients to the clinical presentations and findings of other conventional urologic examinations. METHOD: Intravenous pyelogram(IVP), voiding cystourethrogram(VCUG) and urodynamic study were performed in twenty-five spinal cord injured patients along with serum BUN/Creatinine levels and 24 hour creatinine clearance tests. Technetium-99 m mercaptoacetyltriglycine was used for the radioisotope renography. RESULTS: One abnormal radioisotope renography finding was noted among 22 normal findings by IVP and VCUG studies, while no abnormal finding by IVP and VCUG studies was noted among the subjects with a normal radioisotope renography. Effective renal plasma flow(ERPF) was significantly lower in patients with lower creatinine clearance. ERPF, cortical retention and creatinine clearance values for hyperreflexic bladders were significantly different from areflexic bladders. ERPF was significantly higher in a clean intermittent catheterization group than in a percussion and Cred method group for the hyperreflexic bladders. CONCLUSION: The study proves that the radioisotope renography is a sensitive and valuable study to evaluate the renal dysfunction in the spinal cord injured patients.
Creatinine ; Humans ; Intermittent Urethral Catheterization ; Percussion ; Plasma ; Radioisotope Renography* ; Renal Plasma Flow, Effective ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urodynamics

It has long been known that acetylcholine infusion resulted in increases in urine volume, urinary excretion of Na and renal plasma flow. Exact mechanism of renal effects of acetylcholine, however, has not yet been clarified. Since the discovery of endothelium-derived relaxing factor/nitric oxide system, the vascular endothelium has been considered as an endocrine gland. The purpose of the present study was to define the effect of acetylcholine on the renal hemodynamic and tubular function, and the modification of the renal effects of acetylcholine in two- kidney one clip Goldblatt hypertensive rabbits. Intrarenal acetylcholine(0.03-0.3ug/kg/min) increased glomerular filtration rate(GFR, CCr), renal plasma flow (RPF, CPAH), urine volume(UV), free water clearance (CH2O), urinary excretion of electrolytes(UNaV, UKV) and nitrate(UNO3V) and fractional excretion of Na+ (FENa) in unanesthetized rabbits. No change in filtration fraction was observed. Pretreatment with N omega- nitro-L-arginine methyl ester(L-NAME) blocked the acetylcholine-induced renal effects. Acetylcholine infused into the contralateral kidney elicited increases in GFR, RPF, UV, CH2O, UNaV, UKV, UNO3V and FENa in hypertensive rabbits. The hemodynamic effect was not different between normotensive sham-operated and unilateral nephrectomized rabbits. Acetylcholine-induced tubular effect, however, was significantly accentuated in hypertensive rabbits. Neither the renal hemodynamic nor tubular effects of acetylcholine were observed with pretreatment of L-NAME. These results suggest that the renal tubular effect as well as hemodynamic effect of acetylcholine is mediated through the NO system and that the tubular effect of acetylcholine is accentuated in the early phase of renal hypertension.
Acetylcholine* ; Endocrine Glands ; Endothelium, Vascular ; Filtration ; Hemodynamics ; Hypertension, Renal ; Kidney ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Rabbits* ; Renal Plasma Flow ; Water