Increased plasma viscosity as a reason for inappropriate erythropoietin formation.

The aim of this study was to examine whether altered plasma viscosity could contribute to the inappropriately low production rate of erythropoietin (EPO) observed in patients suffering from hypergammaglobulinemias associated with multiple myeloma or Waldenström's disease. We found that the EPO formation in response to anemia in these patients was inversely related to plasma viscosity. A similar inverse relationship between plasma viscosity and EPO production was seen in rats in which EPO formation had been stimulated by exchange transfusion and the plasma viscosity of which was thereby altered by using exchange solutions of different composition to alter plasma viscosity and thus whole blood viscosity independently from hematocrit. Raising the gammaglobulin concentration to approximately 40 mg/ml plasma in the rats almost totally blunted the rise in serum EPO levels despite a fall of the hematocrit to 20%. Determination of renal EPO mRNA levels by RNase protection revealed that the reductions in serum EPO levels at higher plasma viscosities were paralleled by reductions in renal EPO mRNA levels. Taken together, our findings suggest that plasma viscosity may be a significant inhibitory modulator of anemia-induced EPO formation. The increased plasma viscosity in patients with hypergammaglobulinemias may therefore contribute to the inappropriate EPO production, which is a major reason for the anemia developing in these patients.

Conservative treatment with ketoacid and amino acid supplemented low-protein diets in chronic renal failure.

Twenty-six patients with advanced renal failure (glomerular filtration rate less than 6 ml/min) were treated with a mixed quality low protein diet and ketoacid analogues. An improvement in nitrogen balance, serum transferrin and phosphate, and base excess was observed after 2 weeks of treatment. In a longer term study, the result of 20 patients treated with ketoacids for up to 14 months were compared to a group 40 patients who received a low-protein diet with essential amino acids. Patients responded similarly to the two diets; however, the group receiving ketoacids had a significantly lower glomerular filtration rate. There was improvement in calcium and phosphate metabolism with ketoacid treatment. The patients were able to tolerate treatment with both the ketoacids and vitamin D.

Differential effects of extracellular anions on renin secretion from isolated perfused rat kidneys.

We investigated the relevance of anions for the regulation of renin secretion from the kidneys. For this purpose we measured renin release from isolated rat kidneys that were perfused with medium containing either 120 mmol/l (normal) chloride or 95 mmol/l of isethionate, acetate, or nitrate anions in exchange for equimolar amounts of chloride. Lowering the extracellular chloride concentration by either of these maneuvers significantly enhanced renin secretion rates (RSR) at a perfusion pressure of 100 mmHg. Increasing pressure above 100 mmHg inhibited renin release in the presence of isethionate and acetate but not with nitrate anions. The renin stimulatory effects of isethionate and acetate but not that of nitrate anions disappeared in the presence of bumetanide (100 mumol/l), an inhibitor of macula densa chloride transport. Activation of renin secretion by isethionate and acetate was blunted with 100 pmol/l angiotensin II (ANG II), whereas tenfold higher concentrations of ANG II were required to attenuate the effect of nitrate ions. The amount of renin released in the presence of nitrate was fully additive to RSR values obtained with maximally effective doses of isoproterenol. These findings are consistent with the idea that impermeant anions such as isethionate and acetate enhance renin secretion from the kidneys predominantly via the tubular macula densa mechanism. The stimulatory influence of membrane-permeable nitrate anions appears to involve additional pathways and is mediated by a decreased calcium sensitivity of the renin secretory process rather than resulting from an adenosine 3',5'-cyclic monophosphate-dependent action.

Role of calcium ions in the pressure control of renin secretion from the kidneys.

In this study we examined the role of calcium ions in the control of renin release by the renal artery pressure. For this purpose renin secretion rates (RSR) were measured in isolated rat kidneys perfused at pressures of 140, 100, 80 and 40 mmHg (19, 13, 11, 5 kPa) with media containing either 1.5 mmol/l ("normal") or zero calcium concentrations (calcium-free perfusate with 0.5 mmol/l EGTA). At normal calcium the RSR was inversely related to the renal artery pressure, whereas calcium withdrawal resulted in an almost linear and proportional relationship between RSR and perfusion pressure. As a consequence, RSR at 140 mm Hg (19 kPa) with a calcium-free medium was similar to renin release at 40 mm Hg (5 kPa) with normal calcium. The nitric oxide (NO) donor sodium nitroprusside (1 mumol/l) stimulated RSR in a pressure-dependent fashion at a calcium concentration of 1.5 mmol/l. With a calcium-free perfusate, sodium nitroprusside did not restore the inverse pressure dependence of RSR seen with normal calcium but almost doubled the RSR across the whole pressure range. Whilst RSR was significantly reduced by angiotensin II (1 nmol/l) in the range between 40 mmHg and 140 mmHg (5-19 kPa) with normal calcium, withdrawal of extracellular calcium ions practically abolished the inhibitory action of angiotensin II. Since angiotensin II attenuated RSR especially at low renal perfusion pressure, our results indicate that renin release in this pressure range is still inhibitable by calcium mobilization in renal juxtaglomerular cells. Thus, the enhancement of renin secretion at lower pressures cannot be explained by a decreased sensitivity of renin release towards calcium ions.(ABSTRACT TRUNCATED AT 250 WORDS)

Mode of nitric oxide action on the renal vasculature.

Our study aimed to characterize the essential cellular pathways along which nitric oxide (NO) exerts its well-known vasodilatatory properties in the kidney. Using the isolated perfused rat kidney model we examined the roles of potassium channels, cGMP-protein kinase activity and cAMP-phosphodiesterases (PDE) in the effect of NO on renovascular resistance. We found that neither potassium channel activity nor G-kinase activity was essential for the vasodilatatory effect of NO. The effect of NO, however, was essentially mimicked by pharmacological inhibition of PDE-3, which is a cGMP-inhibitable PDE. As PDE-3 is strongly expressed in renal preglomerular vessels and NO stimulates cGMP formation in renal vessels, it appears likely that inhibition of cAMP degradation and consequently the cAMP pathway are crucially involved in mediating the effects of NO on renal vascular resistance.

Oxygen transport and acid-base balance in the blood of the sheatfish, Silurus glanis.

Oxygen binding and buffer properties of the blood of the sheatfish, Silurus glanis, were investigated in vitro at 20 and 10 degrees C. The O2 binding curves were hyperbolic with P50 = 10.1 mm Hg (20 degrees C, pH = 7.5) and 4.6 (10 degrees C, pH = 7.5). There was a very large Bohr effect with an average delta log P 50/delta pH of - 1.14. At 20 degrees C this value tended to be higher than at 10 degrees C. As a consequence the apparent heat of oxygenation depended on pH. The mean value of delta H was -10.4 kcal/mol. The Haldane effect was pronounced too (delta pH/delta S = -0.14) as was the Root effect. Isoelectric focussing revealed 3 major hemoglobin fractions with isoionic points in a more alkaline region than in carp hemoglobin. The non-bicarbonate buffer value was -10 mmol . 1-1. pH -1. The intraerythrocytic pH depended on the extracellular pH and the O2 saturation: pH = (0.87 - 0.14 S) (pHe -6.68 + 6.48). Delta pH/delta t for a constant CO2 content was -0.0166.

Stimulation of renin secretion by nitric oxide is mediated by phosphodiesterase 3.

This study aimed to characterize the cellular pathways along which nitric oxide (NO) stimulates renin secretion from the kidney. Using the isolated perfused rat kidney model we found that renin secretion stimulated 4- to 8-fold by low perfusion pressure (40 mmHg), by macula densa inhibition (100 micromol/liter of bumetanide), and by adenylate cyclase activation (3 nmol/liter of isoproterenol) was markedly attenuated by the NO synthase inhibitor nitro-L-arginine methyl ester (L-Name) (1 mM) and that the inhibition by L-Name was compensated by the NO-donor sodium nitroprusside (SNP) (10 micromol/liter). Similarly, inhibition of cAMP degradation by blockade of phosphodiesterase 1 (PDE-1) (20 micromol/liter of 8-methoxymethyl-1-methyl-3-(2-methylpropyl)xanthine) or of PDE-4 (20 micromol/liter of rolipram) caused a 3- to 4-fold stimulation of renin secretion that was attenuated by L-Name and that was even overcompensated by sodium nitroprusside. Inhibition of PDE-3 by 20 micromol/liter of milrinone or by 200 nmol/liter of trequinsin caused a 5- to 6-fold stimulation of renin secretion that was slightly enhanced by NO synthase inhibition and moderately attenuated by NO donation. Because PDE-3 is a cGMP-inhibited cAMP-PDE the role of endogenous cGMP for the effects of NO was examined by the use of the specific guanylate cyclase inhibitor 1-H-(1,2,4)oxodiazolo(4,3a)quinoxalin-1-one (20 micromol). In the presence of 1H-[1,2,4]oxodiazolo[4,3-a]quinoxalin-1-one the effect of NO on renin secretion was abolished, whereas PDE-3 inhibitors exerted their normal effects. These findings suggest that PDE-3 plays a major role for the cAMP control of renin secretion. Our findings are compatible with the idea that the stimulatory effects of endogenous and exogenous NO on renin secretion are mediated by a cGMP-induced inhibition of cAMP degradation.

Effects of endothelins on renin secretion from rat kidneys.

Using a preparation of isolated rat kidneys perfused at constant renal artery pressure (80 mmHG) we investigated the role of endothelins in the regulation of renin release. Addition of three related endothelins (ET-1, ET-2, ET-3) at a concentration of 10 pmol L(-1) tended to enhance renin secretion rates. Higher doses (100 pmol L(-1), 1 nmol L(-1)) of different ETs such as the selective ETB receptor agonist sarafotoxin S6c (100 pmol L(-1), 1 nmol L(-1)) inhibited renin release and increased renal vascular resistance with similar potency. These effects of ETs were blunted when calcium ions were removed from the perfusate. Renin release activated by isoproterenol (10 nmol L(-1)) was also significantly reduced with ET-1, -2 and -3 (1 nmol L(-1)). BQ-123 (500 nmol L(-1)), a selective ETA receptor antagonist, only attenuated, whilst the non-selective ET receptor blocker bosentan (Ro 47-0203, 10 micro mol L(-1)) almost abolished the renal vasopressor and renin inhibitory action of ET-1 and sarafotoxin S6c. BQ-123 and bosentan alone did not affect either perfusate flow or basal renin secretion rates in isolated perfused kidneys. These findings indicate that all three ET peptides equipotently inhibit renin secretion from the kidneys. Most of the vasopressor and renin inhibitory effect of ETs is mediated by ETB rather than ETA receptors involving a calcium-dependent signal transduction mechanism. Moreover, our results suggest that intrarenally released ETs do not contribute to the regulation of renin secretion from isolated perfused rat kidneys.

Stimulation of renin secretion by NO donors is related to the cAMP pathway.

This study aimed to characterize the cellular pathways along which nitric oxide (NO) influences the secretion of renin from the kidney. Using the isolated perfused rat kidney model, we found that the NO donor sodium nitroprusside (SNP) (1-30 mumol/l) induced a prompt, concentration-dependent fourfold increase of basal renin secretion. The membrane-permeable cGMP analogs 8-bromo-cGMP and 8-(4-chlorophenylthio)-cGMP (8-pCPT-cGMP; each 5-50 mumol/l) inhibited basal renin secretion and attenuated the stimulation of renin secretion by SNP. Conversely, the renin stimulatory effect of SNP was enhanced in the presence of the G kinase inhibitor Rp-8-CPT-cGMPS (10 mumol/l). The renin stimulatory effect of SNP was amplified in nominally calcium-free perfusate and was abolished in the presence of angiotensin II (1 nmol/l). Renin secretion stimulated by SNP was clearly attenuated by the A kinase inhibitor Rp-8-CPT-cAMPS (25 mumol/l). These findings indicate that the renin stimulatory effect of NO donors in renal juxtaglomerular cells cannot be explained by activation of G kinase and is also less likely to be causally related to the regulation of renin secretion by calcium. Because A kinase activity is required for the stimulation of renin secretion by SNP, it appears as if the renin stimulatory effect is causally related to the cAMP pathway controlling renin secretion.

Oxygen binding and acid base status of the blood from the freshwater turtle, Phrynops hilarii.

Oxygenation studies with the whole blood of Phrynops hilarii show a P50 of 38 torr at extracellular pH (pHe) of 7.4 which corresponds to an intracellular pH (pHi) of 7.05 at 25 degrees C. The blood CO2 Bohr effect was -0.56 when related to pHi. pHi is related to pHe by the following equation: pHi = 0.75.pHe + 1.54 (r = 0.99); pHi = 0.72. pHe + 1.72 (r = 0.96) at 10 and 25 degrees C respectively. Blood pHe, for 25 degrees C, was 7.519 +/- 0.254 (n = 6). Blood gas partial pressures were: pCO2 = 25.8 +/- 3.8 torr (n = 6); pO2 = 61.7 +/- 21.2 torr (n = 6). The major red cell phosphates, in mmole/l erythrocytes, n = 6, were: ATP (3.66 +/- 0.86); GTP (0.53 +/- 0.28); 2.3-DPG (0.32 +/- 0.12) and inorganic phosphates (2.00 +/- 0.35). The plasma inorganic ion composition, n = 6, was, in mEq/l: K+ (3.04 +/- 0.40); Na+ (148.4 +/- 12.6); Ca2+ (4.75 +/- 1.32); Cl- (106.6 +/- 5.0). Additional blood parameters of interest (n = 6) were: lactate (2.07 +/- 1.72 mM in plasma); erythrocytes/mm3 (416 X 10(3) +/- 4.6 X 10(3)); leucocytes/mm3 (44636 +/- 2618); haematocrit (%) (14.5 +/- 3.6); haemoglobin, g/dl (3.2 +/- 0.5); plasma protein g/dl (4.4 +/- 0.4); osmolarity (293 +/- 10 mOsm/l). The non-bicarbonate buffer value was -22.6 mmol/kg H2O/pH. For a constant CO2 content, delta pHe/delta t = 0.0141 +/- 0.002 (n = 18) and delta pHi/delta t = 0.0157 +/- 0.003 (n = 18).

Influence of phosphate restriction, keto-acids and vitamin D on the progression of chronic renal failure.

Progression of renal failure was investigated in a prospective follow-up study of 60 patients with mild and 100 patients with advanced renal failure. Phosphate restriction in mild and protein restriction in advanced renal failure can delay the progression rate of patients with chronic renal insufficiency. Simultaneous administration of Vitamin D does not effect the progression. Administration of keto-acids to the low protein diet has a strong delaying effect on the progression rate.