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*

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

BACKGROUDN: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis. METHODS: We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy <20 umol/L) consisted of 74 ESRD patients who have taken continual usual dose folate (1 mg/day). Group II (tHcy> or =20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment. RESULTS: The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9+/-6.4 mol/L, 20 PD: 18.0+/-16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98+/-1.4, lower extremities (LE)-PWV 10.15+/-1.3, upper extremities (UE)-PWV 8.80+/-0.8 (m/s); 8 PD: Ao-PWV 9.32+/-1.8, LE-PWV 10.64+/-1.4, UE-PWV 9.24+/-0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9+/-4.9 mol/L->13.5+/-6.1 for 5 Group II patients: 34.3+/-27.5 mol/L->23.0+/-5.9 mol/L (p<0.05, paired t-test). No difference in the PWV was found before and after folic acid supplementation for the two groups (p>0.05, paired t-test). CONCLUSIONS: We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients.
Angioplasty ; Aorta ; Atherosclerosis ; Blood Flow Velocity ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Disease ; Fasting ; Folic Acid* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Kidney Failure, Chronic* ; Lower Extremity ; Mass Screening ; Mortality ; Peritoneal Dialysis ; Plasma ; Pulse Wave Analysis* ; Renal Dialysis ; Risk Factors ; Thrombosis ; Upper Extremity

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

OBJECTIVETo investigate the effect of traditional classical compound Wulingsan on renal hemodynamic in rats with adriamycin (ADR)-induced nephrosis.

METHODAfter establishing a model of rats with adriamycin-induced nephrosis, we administrated wulin-san to the ADR rats via oral gavage for four weeks and measured mean arterial blood preasure (MABP) with manometer. Renal clearance of paraaminohippuric acid (PAH) and inulin were detected, then renal plasma flow (RPF) and glomerular filtration rate (GFR) were calculated. Renal vascular resistance (RVR) was calculated as the division of MABP by RPF. Renal endothelin (ET) and angiotensin II (Ang II) were detected with radioimmunity assay kits, and nitrous oxide (NO) was detected with biochemical kits.

RESULTThere was no significant change of GFR in ARD rats, but RPF and NO were decreased, which accompanied by enhanced RVR, ET and Ang II. RPF was increased in the administrated rats, in company with RVR, ET and Ang II decreased, whereas NO was not influenced after the administration.

CONCLUSIONWulingsan can improve the renal hemodynamic in ADR rats, at least in part by modulating the levels of vasoactive factor.

Angiotensin II ; metabolism ; Animals ; Doxorubicin ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Endothelins ; metabolism ; Glomerular Filtration Rate ; drug effects ; Kidney ; metabolism ; physiopathology ; Male ; Medicine, Chinese Traditional ; Nephrosis ; chemically induced ; metabolism ; physiopathology ; Nitrous Oxide ; metabolism ; Plant Extracts ; pharmacology ; Plants, Medicinal ; chemistry ; Rats ; Rats, Sprague-Dawley ; Renal Circulation ; drug effects ; Renal Plasma Flow ; drug effects ; Vascular Resistance ; drug effects

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*

PURPOSE: Nephrectomy or decortication is used to relieve pain in clinical autosomal dominant polycystic kidney disease (ADPKD). We evaluated the renal adaptation to unilateral nephrectomy, and segmental renal artery infarction in APDKD rats. MATERIALS AND METHODS: At 6 weeks of age, cystic Han: Sprague-Dawley (SPRD) rats and unaffected controls were subjected to renal mass reduction by uninephrectomy, by infarction of half of each kidney or sham operation. Most groups were followed up to the age of 20 weeks, with serial measurements of blood pressure and proteinuria. At 20 weeks, glomerular filtration rate (GFR) and renal plasma flow (RPF) rate were measured. Similar studies to 12 weeks of age were performed in additional groups of control and cystic rats with either sham operation or half renal infarction. RESULTS: In the uninephrectomized control rats, the values for systemic blood pressure and proteinuria increased, but not significantly. Renal compensatory hyperfiltration and hyperperfusion were observed. GFR and RPF exceeded those seen in sham operated rats (p< 0.05). In infarcted control rats showed significantly increased values for blood pressure and proteinuria and a marked reduction in GFR and RPF (p< 0.05). In the uninephrectomized cystic rats, at baseline, increased values for blood pressure and proteinuria, and a significant reduction in GFR and RPF were observed (p< 0.05). In infarcted cystic rats, at baseline, significant increased values for blood pressure and proteinuria were observed. And there was a marked reduction in GFR and RPF associated with a significant increase in renal vascular resistance (p<0.05). However, in both cystic groups, no compensatory hyperfiltration or hyperperfusion was observed after renal mass reduction. CONCLUSIONS: APDKD is vulnerable state to additional renal injury. When treatment is required for patients with symptomatic APDKD, clinical need to conserve renal function should be considered, especially such as cyst marsupialization.
Animals ; Blood Pressure ; Glomerular Filtration Rate ; Humans ; Infarction ; Kidney ; Nephrectomy ; Polycystic Kidney, Autosomal Dominant ; Proteinuria ; Rats* ; Rats, Sprague-Dawley ; Renal Artery ; Renal Plasma Flow ; Vascular Resistance

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

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: Compensatory renal hypertrophy(CRH) after loss of considerable renal volume is essential process for recovery and maintenance of renal function, but on the other hand CRH induces glomerulosclerosis, eventually renal failure. Recently, the considerable studies reveal that insulin-like growth factor-I(IGF-I) is an important molecule relating to renal hypertrophy. This study investigates the possibility of IGF-I as a therapeutic agent, it should be proved whether external IGF-I affects renal function and glomerulosclerosis or does not affect in devoid state of growth hormone(GH) effect. MATERIALS AND METHODS: 100?150g Sprague-Dawley male rats were hypophysectomized by transpharyngeal approach and hypophysectomy were confirmed by daily monitoring of body weight for 3weeks. 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 IGF-I group(IGF-I treated). Recombinant IGF-I were administered via Alzet osmotic minipump for 5 days in rats of IGF-I group and UNX+IGF-I group. At the 5th day after uninephrectomy, the glomerular filtration rate(GFR) and the effective renal plasma flow(ERPF) were investigated by measuring recovery of 99mTc-DTPA and 125I-hippurate, and then the rats were sacrificed and the kidneys were removed. The wet kidney weights were measured in removed kidneys, renal IGF-I concentrations were measured by RIA, and cellular proliferation were evaluated by flow-cytometry. RESULTS: 1. The wet kidney weight per body weight significantly increased after uninephrectomy, and had not been affected by IGF-I treatment regardless of uninephrectomy. 2. Renal IGF-I tended to increase after uninephrecromy, and significantly increased with IGF-I treatment in both IGF-I and UNX+IGF-I. The level of renal IGF-I of UNX+IGF-I group was significantly higher than that of IGF-I group. 3. Total GFR tended to decreased after uninephrectomy and were significantly increased by IGF-I treatment regardless of uninephrectomy. 4. The GFR per g wet kidney weight significantly increased after uninephrectomy, and were significantly increased by IGF-I treatment regardless of uninephrectomy. 5. Total ERPF were not significantly changed after uninephrectomy and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 6. The ERPF per g wet weight significantly increased after uninephrectomy, and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 7. The mean % of S1 phase cells were 33.6% in UNX+IGF-I group, 23.5% in IGF-I group, 19.96% in UNX group, and 10.4% in control group. The mean % of G2+M phase cells were 2.5% in UNX+IGF-I group, 1.95% in IGF-I group, 1.73% in UNX group, and 1.2% in control group. CONCLUSIONS: GH non-dependent IGF-I participate in CRH, and only IGF-I without GH increases renal function. IGF-I treatment during CRH might increase GFR by changing glomerular efferent arteriol of filtration fraction.
Animals ; Body Weight ; Cell Proliferation ; Filtration ; Growth Hormone ; Hand ; Humans ; Hypertrophy ; Hypophysectomy ; Insulin-Like Growth Factor I* ; Kidney* ; Male ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Renal Insufficiency ; Renal Plasma Flow, Effective ; Weights and Measures