In 149 cases, blood pressure response to glucagon test did not exceed 20/10 mm Hg more than the response in the cold pressor test control and was considered negative. Plasma catecholamine level increases may be seen in 95% of patients without pheochromocytomas. Among six patients with pheochromocytomas, urinary metanephrine levels were of diagnostic importance in two with isolated pheochromocytoma and in one with the multiple endocrine neoplasia of type 2 (MEN-type 2). Urinary metanephrine determinations yielded false-negative results in three patients with MEN-type 2, while vanilmandelic acid level was normal in one and nephrotomograms were positive in two of these three. These results suggest that the early diagnosis of pheochromocytoma in patients with MEN-type 2 may be difficult and may require multiple biochemical and roentgenographic investigations.

Simultaneous clearances of inulin (Ci”), creatinine (C,,), and para-aminohippurate (CPah) were measured in volunteer subjects and renal allograft recipients during a 48-hour period after the intravenous administration of 1 Gm. of methylprednisolone. Significant increases in Ci, and Cpah were noted in normal subjects at 24 hours; no significant change occurred in renal allograft recipients. Ci,/C,, ratios remained unchanged in both normal subjects and renal allograft recipients. These data demonstrate no long-term detrimental effect of a single, large dose of methylprednisolone on renal function in normal subjects or in renal allograft recipients. L arge, intermittent, intravenous doses of corticosteroids are clinically and experimentally effective in controlling renal allograft rejection.lms Woods and associates3 have observed minimal stigmata of hypercorticism and a low incidence of complications, including wound healing and gastrointestinal problems, in patients treated with large, daily, intravenous doses of methylprednisolone rather than with high oral doses of steroids. Recently, Webel and co-workers4 have demonstrated that 1 Gm. of methylprednisolone administered intravenously profoundly inhibited lymphocyte transformation in normal subjects ; the response lasted up to 72 hours. This finding suggests that large, intravenous doses of corticosteroids should be efficacious in controlling primarily cell-mediated immunologic reactions such as allograft rejection. A recent study raised questions regarding the use of large, intravenous doses of corticosteroids in treating renal allograft rejection. Popovtzer and associates5 demonstrated an immediate suppression of glomerular filtration rate and effec

While gastric analysis does have a few applications of clinical importance, such as detection of the Zollinger-Ellison syndrome, retained antrum in exclusion, anastomotic ulcer, and incompleteness of vagotomy, other uses involve interpretations upon which there is no common agreement; one often feels that unwarranted refinements are being applied to a test whose basic value remains inadequately substantiated.

The effects of dopamine on renal function were studied in 10 patients with cirrhosis and various degrees of impairment of renal function. Dopamine caused a consistent increase in effective renal plasma flow but little change in glomerular filtration rate or sodium and water excretion. The hemodynamic change is attributed to a direct effect on the renal vasculature, resulting in reduction in both preglomerular and postglomerular resistance. Unlike other drugs, dopamine partially corrects the renal hemodynamic disturbance in cirrhosis, although its role as a therapeutic agent is limited.

Renal clearances of diatrizoate sodium I 125 or iothalamate sodium I 125 measure 90% to 100% of simultaneous classic clearances of inulin; clearances of iodohippurate sodium I 131 or iodopyracet I 131 are 84% and 79%, respectively, of simultaneous clearances of aminohippurate sodium. Plasma binding (8% to 27% of diatrizoate sodium I 125 or iothalamate sodium I 125; 64% to 70% of iodohippurate sodium I 131; 29% to 42% of iodopyracet I 131; 7% to 25% of aminohippurate) is revealed by ultrafiltration studies. Binding is labile and dissociable. Correcting clearances of diatrizoate sodium I 125 or iothalamate sodium I 125 for plasma binding yields values exceeding those of insulin clearances. Uncorrected, they are satisfactory substitutes for inulin clearance in man. Clearances of iodohippurate sodium I 131 or iodopyracet I 131 approximate adequately clearances of aminohippurate when carrier iodopyracet is added and the clearances are corrected for plasma binding to provide an estimate of total clearance.

The rate and extent of return of renal function and its maintenance after initial improvement and factors influencing renal recovery were studied in 186 patients with acute renal failure. Renal function was evaluated by standard clearance techniques (Cinulin, CPAH (para-aminohippurate)) in 40 of 87 survivors. The interval between the episode of acute renal failure and follow-up averaged 45.0 months. Of 36 patients studied more than 3 months after recovery, 22 (61%) had "incomplete" renal functional recovery, or Cinulin and CPAH values more than 1 SD below expected values. Patients with impaired clearances were older at the onset of acute renal failure and had a longer period of oliguria than patients who had "complete" recovery. Failure to regain expected clearance values was apparent in the third decade, and patients 40 years of age or older attained at most 75% of normal values. Serial observations in some suggested a decline in renal function after initial improvement.

Case Studies1 June 1966Angiotensin-induced Natriuresis in Cirrhosis in the Absence of Endogenous Aldosterone SecretionRANDOLPH M. MCCLOY, M.D., WILLIAM P. BALDUS, M.D., W. H. J. SUMMERSKILL, D.M., FRANK T. MAHER, M.D., F.A.C.P.RANDOLPH M. MCCLOY, M.D.Search for more papers by this author, WILLIAM P. BALDUS, M.D.Search for more papers by this author, W. H. J. SUMMERSKILL, D.M.Search for more papers by this author, FRANK T. MAHER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-6-1271 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptFluid retention accompanying advanced cirrhosis is characterized by secondary hyperaldosteronism and increased reabsorption of sodium by the kidney; the nature of the stimulus to increased aldosterone production is uncertain. The augmentation of aldosterone secretion in health resulting from infusion of angiotensin suggests that the latter may function as a trophic hormone for aldosterone (1-3). Whereas infusion of angiotensin causes sodium retention in normal man, patients with cirrhosis may exhibit a natriuretic and diuretic response (2). This paradoxical effect of angiotensin on sodium excretion in cirrhosis has not been explained. An opportunity to investigate the effects of angiotensin on renal function...References1. LARAGH JH: Interrelationships between angiotensin, norepinephrine, epinephrine, aldosterone secretion, and electrolyte metabolism in man. Circulation 25: 203, 1962. CrossrefMedlineGoogle Scholar2. LARAGHCANNONBENTZELSICINSKIMELTZER JHPJCJAMJI: Angiotensin II, norepinephrine, and renal transport of electrolytes and water in normal man and in cirrhosis with ascites. J. Clin. Invest. 42: 1179, 1963. CrossrefMedlineGoogle Scholar3. BIRONCHRETIENKOIWGENEST PMEJ: Effects of angiotensin infusions on aldosterone and electrolyte excretion in normal subjects and patients with hypertension and adrenocortical disorders. Brit. Med. J. 1: 1569, 1962. CrossrefMedlineGoogle Scholar4. EDELMANLEIBMAN ISJ: Anatomy of body water and electrolytes. Amer. J. Med. 27: 256, 1959. CrossrefMedlineGoogle Scholar5. SMITH HW: Principles of Renal Physiology. 237 pages. Oxford University Press, New York, 1956. Google Scholar6. MATTOXLEWBART VRML: The determination of aldosterone in urine. J. Clin. Endocr. 19: 1151, 1959. CrossrefGoogle Scholar7. BALDUSFEICHTERSUMMERSKILLHUNTWAKIM WPRNWHJCKG: The kidney in cirrhosis. II. Disorders of renal function. Ann. Intern. Med. 60: 366, 1964. LinkGoogle Scholar8. BROWNPEART JJWS: The effect of angiotensin on urine flow and electrolyte excretion in hypertensive patients. Clin. Sci. 22: 1, 1962. MedlineGoogle Scholar9. 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GROSSSCHAECHTELINBRUNNERPETERS FGHG: The role of the renin-angiotensin system in blood pressure regulation and kidney function. Canad. Med. Ass. J. 90: 258, 1964. MedlineGoogle Scholar15. EARLEYFRIEDLER LERM: Changes in renal blood flow and possibly the intrarenal distribution of blood during the natriuresis accompanying saline loading in the dog. J. Clin. Invest. 44: 929, 1965. CrossrefMedlineGoogle Scholar16. SCHROEDERSANCETTGABUZDA ETSMGJ: Effects of angiotensin on renal hemodynamics in patients with cirrhosis and ascites. Clin. Res. 12: 258, 1964. Google Scholar17. SELKURT EE: Effect of pulse pressure and mean arterial pressure modification on renal hemodynamics and electrolyte and water excretion. Circulation 4: 541, 1951. CrossrefMedlineGoogle Scholar18. TOBIANCOFFEEFERREIRAMEULI LKDJ: The effect of renal perfusion pressure on the net transport of sodium out of distal tubular urine as studied with the stop-flow technique. J. Clin. Invest. 43: 118, 1964. CrossrefMedlineGoogle Scholar19. VANDER AJ: Inhibition of distal tubular sodium reabsorption by angiotensin II. Amer. J. Physiol. 205: 133, 1963. CrossrefMedlineGoogle Scholar20. LANGFORD HG: Tubular action of angiotensin. Canad. Med. Ass. J. 90: 332, 1964. MedlineGoogle Scholar21. LARAGHCANNONAMES JHPJRP: Interaction between aldosterone secretion, sodium and potassium balance, and angiotensin activity in man: studies in hypertension and cirrhosis. Ibid., p. 248. Google Scholar22. LEYSSACLASSENTHAYSEN PPUVJH: Inhibition of sodium transport in isolated renal tissue by angiotensin (abstract). Biochim. Biophys. Acta 48: 602, 1961. CrossrefMedlineGoogle Scholar23. VAGNUCCILAULERHICKLERTHORN AIDPRBGW: Acute infusion of synthetic angiotensin II in patients with essential hypertension: its effect on renal hemodynamics and on electrolyte and water excretion. Circulation (Supplement) 29: 523, 1964. CrossrefGoogle Scholar24. DAVISHOLMANCARPENTERURQUHARTHIGGINS JOJECCJJT: An extra-adrenal factor essential for chronic renal sodium retention in presence of increased sodium-retaining hormone. Circ. Res. 14: 17, 1964. CrossrefMedlineGoogle Scholar25. RECTORVAN GIESENKIILSELDIN FCGFDW: Influence of expansion of extracellular volume on tubular reabsorption of sodium independent of changes in glomerular filtration rate and aldosterone activity. J. Clin. Invest. 43: 341, 1964. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the Gastrointestinal Research Unit, Section of Medicine, and Section of Clinical Pathology, Mayo Clinic and Mayo Foundation, and the Mayo Graduate School of Medicine, Rochester, Minn.This study was supported in part by research grant AM-06908, National Institutes of Health, Bethesda, Md.Dr. McCloy was the recipient of grant AM-5259, National Institutes of Health, Bethesda, Md.Requests for reprints should be addressed to 200 First St. S.W., Rochester, Minn. 55901. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByInappropriately low angiotensin II generation: a factor determining reduced kidney function and survival in patients with decompensated cirrhosis 1 June 1966Volume 64, Issue 6Page: 1271-1276KeywordsAldosteroneCirrhosisDiureticsExcretionGraduate medical educationHormonesKidneysNatriuretic peptidesResearch grantsSodium Issue Published: 1 June 1966 PDF DownloadLoading ...

Summary Renal performances during clinical cardiopulmonary bypass, with and without hemodilution, were compared. The major difference consisted of a significantly larger rate of urine flow and a lower osmolality of urine during and immediately after cardiopulmonary bypass when hemodilution was utilized. Explanations for these phenomena were discussed. Glomerular filtration rate, effective renal plasma flow, and postoperative urine electrolyte excretion and osmolality patterns were generally similar in both groups of patients. It was concluded that the increased production of urine associated with hemodilution perfusion might well protect renal-tubular integrity during stressful situations, such as intracardiac surgery.