PURPOSE: In chronic renal failure (CRF), extracellular fluid (ECF) volume is maintained close to normal, often until end-stage renal disease is imminent. This remarkable feat is accomplished by an increase in fractional excretion of sodium (FENa) in inverse proportion to the decline in glomerular filtration rate (GFR). Many researchers have carried out to try to indentify in animal study but human study was not done in Korea. METHODS: The study is an investigation of the changes of plamsa and urine electrolytes and FENa and fractional excretion of potassium (FEK) in 19 patients (13 men and 6 women) with chronic renal failure. Ages of 19 patients were average 54.6 year-old (range, 29-74 years). Underlying renal disease of the CRF was 42.1% in diabetic nephropathy, 31.6% in chronic glomerulonephritis, 10.5% in hydronephrosis with ureter reflux, and 5.3% in IgA nephropathy. RESULTS: In CRF, plasma Na+ is decreased significantly from normal control 141 +/- 2.1 mEq/L to 139.9 +/- 3.2 mEq/L and GFR from 75.9 +/- 42.9 mL/min to 9.7 +/- 6.3 mL/min, but plasma K+ is increased significantly from 4.2 +/- 0.4 mEq/L to 4.7 +/- 0.8 mEq/L. In CRF however, urine Na+ is decreased significantly from normal control 175.4 +/- 68.5 mEq/L to 89.9 +/- 31.6 mEq/L and osmolality from 610.6 +/- 210.9 mOsm/kg to 397.7 +/- 119.1 mOsm/kg, but urine K+ is decreased tendency from control 32.1 +/- 22.7 mEq/L to 24.3 +/- 14.8 mEq/L. FENa, FEK, and transtubular potassium gradient (TTKG) on CRF were 3.4 +/- 5.4%, 15.4 +/- 20.8% 7.1 +/- 6.9% each and 0.6 +/- 0.6%, 2.2 +/- 2.3% 3.2 +/- 2.8% on normal persons. The difference between CRF and normal control in FENa, FEK, TTKG and osmolar clearance were statistically significant. CONCLUSION: These results suggest that renal tubular cells of CRF were responsible for the decreased Na+ and K+ reabsorption and enhance K+ secretion.
Animals ; Diabetic Nephropathies ; Electrolytes ; Extracellular Fluid ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Hydronephrosis ; Kidney Failure, Chronic* ; Korea ; Male ; Osmolar Concentration ; Plasma ; Potassium ; Sodium ; Ureter

It has been commonly noted that male patients have worse prognosis in adult polycystic kidney disease, IgA nephropathy, and membranous nephropathy. Several animal experiments were performed to clarify the mechanisms by which male gender confers a more adverse renal prognosis. Obese Zucker rats are characterized by severe obesity, insulin resistance, extremely high serum insulin level, high cholesterol level and spontaneous glomerular sclerosis. The aim of current study was to investigate whether there was a gender difference in 1) mean arterial pressure and renal function 2) glomerular volume by renal perfusion 3) glomerular hemodynamic factors including glomerular blood flow, glomerular pressure, renal vascular resistance, ultrafiltration coefficient by micropuncture techniques in obese male and female Zucker rats. There was no difference in blood glucose, serum insulin level, mean arterial pressure and glomerular sclerosis rate between male and female Zucker rats. Male Zucker rats had slightly higher glomerular filtration rate, kidney weight, single nephron glomerular filtration rate, glomerular capillary hydraulic pressure which was statistically insignificant. These findings suggest that gender difference in hemodynamic factors does not play a role in the progression of renal disease in obese Zucker rats.
Animal Experimentation ; Animals ; Arterial Pressure ; Blood Glucose ; Capillaries ; Cholesterol ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Hemodynamics* ; Humans ; Insulin ; Insulin Resistance ; Kidney ; Male ; Nephrons ; Obesity, Morbid ; Perfusion ; Polycystic Kidney, Autosomal Dominant ; Prognosis ; Punctures ; Rats* ; Rats, Zucker ; Sclerosis ; Ultrafiltration ; Vascular Resistance

No abstract available.
Cystitis*

Due to their unique living conditions and dietary habits, the Koreans' renal function model may be different from that of the Western people. About 40 years ago, a researcher reported that two thirds of the urine osmolality in Koreans was contributed by NaCl, while less than 1/3 by urea. It is known that the Koreans' daily consumption of NaCl is higher while their protein intake is lower, compared to that of the Westerners. Now-a-days, the Korean's dietary habit is changing to a westernized life style. In this study, we investigated whether there were changes in urine composition and osmolality according to age. The subject of study were 215 Koreans (128 male, 142 female, age 7-68 years) living in the Chonbuk and Chonnam province in Korea. We performed routine physical examinations and analyses of the urine Na+, K+, Cl-, urea, NH3, creatinine, and osmolality on their 24 hour urine samples. In the case of the male, total body water, Na and Cl excretion, urine ammonia excretion were significantly changed between groups. In the case of the female, total body water and urine creatinine excretion were significantly changed between groups. We calculated the urine osmolar contribution of NaCl and urea. Our results showed that NaCl composed 63.6 % of total urine osmolality and Urea composed 36.4% of total urine osmolality. In conclusion, urine osmolar composition is similar to the 1960's, but further studies are required to elucidate the change of urine composition in this population for another 50 years.
Ammonia ; Body Water ; Creatinine ; Female ; Food Habits ; Humans ; Jeollabuk-do ; Jeollanam-do ; Korea ; Life Style ; Male ; Osmolar Concentration ; Physical Examination ; Social Conditions ; Urea

BACKGROUND: To study the distribution of the polymorphism of apo E and angiotensin converting enzyme genotypes in type 2 diabetic patients and to evaluate possible association between the apo E genotypes and angiotensin converting enzyme genotypes and intima-media thickness of the common carotid artery. METHODS: Study participants were 206 type 2 diabetic patients (112 men and 94 women), aged 18-81 years. HbA1C, albuminuria, and lipid status were assessed by standard laboratory techniques ; the apo E genotypes were assessed by modified amplification refractory mutation system of polymerase chain reaction technique and the angiotensin converting enzyme genotypes were assessed by multiplex polymerase chain reaction technique. The intima-media thickness was measured by high-resolution ultrasonography. RESULTS: The apo E allele frequencies of patients were E2 11%, E3 72%, and E4 17%. Mean HDL-cholesterol was lower in E4 carrier (n=35) than E2 (n=148) and E3 (n=35) carrier. E2 carriers has less common carotid intima-media thickness than E3 and E4 carriers (p< 0.05). The angiotensin converting enzyme genotypes were distributed as follows ; II 38%, ID 47%, DD 15%. The intima-media thickness value did not differ among patients with various genotypes. Multiple logistic regression analysis showed that only apo E polymorphism was determinant for the intima-media thickness. CONCLUSION: Our results suggested that apo E polymorphism was associated with carotid artery intima-media thickness in type 2 diabetic patients. But we could not find an association between carotid artery intima-media thickness and angiotensin converting enzyme genotype in this patients population.
Albuminuria ; Angiotensins* ; Apolipoproteins E ; Apolipoproteins* ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Diabetes Mellitus* ; Gene Frequency ; Genotype ; Humans ; Logistic Models ; Male ; Multiplex Polymerase Chain Reaction ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Ultrasonography

BACKGROUND: We evaluated the distribution of the polymorphisms of apolipoprotein E and angiotensin converting enzyme gene in patients with diabetic nephropathy and also evaluated possible association between the apolipoprotein E carriers and angioten-sin converting enzyme genotypes and intima-media thickness of the common carotid artery. METHODS: Study participants were 92 patients with diabetic nephropathy(50 men and 42 women). Hb(A1C), albuminuria, and lipid status were assessed by standard laboratory techniques ; the apolipoprotein E carriers were assessed by modified amplification refractory mutation system and the angioten-sin converting enzyme genotypes were assessed by polymerase chain reaction. The intima-media thickness was measured by high-resolution ultrasonography. RESULTS: The apolipoprotein E frequencies of patients were E2 8%, E3 76%, and E4 16%. The intima-media thickness varied by apo E groups. E2 group has less common carotid intima-media thickness than E3 and E4 groups(p<0.05). The angiotensin converting enzyme genotypes were distributed as follows ; 35% II, 49% ID, 16% DD. The intima-media thickness value did not differ among patients with various angiotensin converting enzyme genotypes. Multiple logistic regression analysis showed that age and apolipoprotein E genotypes were determinants for the intima-media thickness. CONCLUSION: Our results suggested that apolipoprotein E polymorphism is associated with carotid artery intima-media thickness in diabetic nephropathy. But, we could not find an association between carotid artery intima-media thickness and angiotensin converting enzyme gene polymorphism in diabetic nephropathy.
Albuminuria ; Angiotensins* ; Apolipoproteins E ; Apolipoproteins* ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Diabetic Nephropathies* ; Genotype ; Humans ; Logistic Models ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Ultrasonography*

Angiotensin converting enzyme gene insertion/ deletion polymorphism has been shown to be associated with cardiovascular disease including cardiomyopathy, myocardial infarction, essential hypertension, progression of IgA nephropathy and diabetic nephropathy. Since glomerulosclerosis has similarities to atherosclerosis, angiotensin converting enzyme gene polymorphism may be associated with glomerulsclerosis. Therefore, we tested whether genotype distribution of the insertion/deletion polymorphism in angiotensin converting enzyme gene is different in patients with minimal change nephrotic syndrome and focal segmental glomerulosclerosis. In genotype distribution of the angiotensin converting enzyme gene I/D polymorphism, control subjects were II type 44.3%, ID type 40.9%, DD type 14.8% and patients with minimal change nephrotic syndrome were II type 38.2%, ID type 45.5%, DD type 16.3% and patients with focal segmental glomerulosclerosis were II type 13.3%, ID type 46.7%, DD type 40.0%. This result suggests that DD genotype was more frequent in patients with focal segmental glomerulosclerosis than minimal change nephrotic syndrome and control subjects. We also examined the association between ACE genotype and clinical characteristics in the patients with minimal change nephrotic syndrome and focal segmental glomerulosclerosis. There were no significant association between I/D polymorphism distribution and hypertension, chronic renal failure, response to steroid in patients with minimal change nephrotic syndrome. The incidence of chronic renal failure in patients with focal segmental glomerulosclerosis DD genotype was higher than that of other genotypes. The response rate to steroid in patients with focal segmental glomerulosclerosis DD genotype was lower than that of other genotypes.
Angiotensins* ; Atherosclerosis ; Cardiomyopathies ; Cardiovascular Diseases ; Diabetic Nephropathies ; Genotype ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic ; Myocardial Infarction ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Peptidyl-Dipeptidase A*