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transtubular gradient

Lise Bankir, Antonio Barbato, Ornella Russo, Gilles Crambert, Roberto Iacone, Nadine Bouby, Ludovica Perna, Pasquale Strazzullo
Plasma potassium concentration (PK ) is tightly regulated. Insulin is known to favor potassium entry into cells. But how potassium leaves the cells later on is not often considered. Previous studies in rats showed that glucagon infusion increased urinary potassium excretion dose-dependently and reversibly. This prompted us to investigate the possible influence of glucagon on potassium handling in humans. We took advantage of the Gly40Ser mutation of the glucagon receptor (GR) that results in a partial loss of function of the GR...
April 2018: Physiological Reports
Daniela Chlíbková, Pantelis T Nikolaidis, Thomas Rosemann, Beat Knechtle, Josef Bednář
Purpose: Hypohydration and hyperhydration are significant disorders of fluid metabolism in endurance performance; however, little relevant data exist regarding multi-stage endurance activities. The aim of the present study was to examine the effect of running seven marathons in 7 consecutive days on selected anthropometric, hematological and biochemical characteristics with an emphasis on hydration status. Methods: Participants included 6 women and 20 men (age 42.6 ± 6.2 years). Data was collected before day 1 (B1 ) and after day 1 (A1 ), 4 (A4 ), and 7 (A7 )...
2018: Frontiers in Physiology
Tae Won Lee, Eunjin Bae, Kyungo Hwang, Ha Nee Chang, Hee Jung Park, Dae-Hong Jeon, Hyun Seop Cho, Se-Ho Chang, Dong Jun Park
RATIONALE: Severe hypokalemia can be a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness. PATIENT CONCERNS: We report a case of severe hypokalemic paralysis and rhabdomyolysis in a 28-year-old bodybuilder. He was admitted to the emergency room due to progressive paralysis in both lower extremities, which had begun 12 hours earlier. He was a bodybuilder trainer and had participated in a regional competition 5 days earlier...
October 2017: Medicine (Baltimore)
Rittirak Othong, Satariya Trakulsrichai, Winai Wananukul
INTRODUCTION: Diospyros rhodocalyx (Tako-Na) is a Thai folk medicine purported to promote longevity, treat impotence, etc. We present patients with hypokalemia, weakness and hypertension after consuming Tako-Na tea. CASE SERIES: Case 1: A 61-year-old man was brought in nine hours after drinking 400-500 mL of Tako-Na tea. One handful of Tako-Na bark was boiled in water to make tea. He had vomiting and watery diarrhea six hours after drinking it. He took no medications and had no history of hypertension...
November 2017: Clinical Toxicology
Marie Mitani, Munehiro Furuichi, Satoshi Narumi, Tomonobu Hasegawa, Motoko Chiga, Shinichi Uchida, Seiji Sato
Pseudohypoaldosteronism type II (PHA II) is a renal tubular disease that causes hyperkalemia, hypertension, and metabolic acidosis. Mutations in four genes (WNK4, WNK1, KLHL3, and CUL3) are known to cause PHA II. We report a patient with PHA II carrying a KLHL3 mutation, who also had congenital hypopituitarism. The patient, a 3-yr-old boy, experienced loss of consciousness at age 10 mo. He exhibited growth failure, hypertension, hyperkalemia, and metabolic acidosis. We diagnosed him as having PHA II because he had low plasma renin activity with normal plasma aldosterone level and a low transtubular potassium gradient...
October 2016: Clinical Pediatric Endocrinology: Case Reports and Clinical Investigations: Official Journal of the Japanese Society for Pediatric Endocrinology
Ranga M Weerakkody, Pushpa N Lokuliyana, Ruchika D Lanerolle
Hump-nosed viper (Hypnale hypnale; HNV) is one of the six major snake species in Sri Lanka that cause envenomation. Nephrotoxicity, coagulopathy, and neurotoxicity are wellrecognized features of its envenomation. Type 4 renal tubular acidosis (RTA4) has only once been described previously in this condition, and we report two further cases. Two patients aged 53 and 51 presented following HNV bites with acute kidney injury and microangiopathic hemolytic anemia. Both underwent multiple cycles of hemodialysis until the polyuric phase was reached...
September 2016: Saudi Journal of Kidney Diseases and Transplantation
Taiki Sakaguchi, Akio Hirata, Kazunori Kashiwase, Yoshiharu Higuchi, Tomohito Ohtani, Yasushi Sakata, Yukihiro Koretsune, Yoshio Yasumura
BACKGROUND: The monitoring of tissue hypoperfusion and the subsequent neurohumoral activation (ie, arterial underfilling) during decongestion is important for the management of acute decompensated heart failure (ADHF). The transtubular potassium concentration gradient (TTKG) has been reported to be a marker of renal aldosterone bioactivity. This study tested the hypothesis that TTKG can be a surrogate of arterial underfilling in patients with ADHF. METHODS AND RESULTS: We measured TTKG at discharge in 100 ADHF patients...
August 25, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
A Uçar, Y Aydemir, A Doğan, E Tunçez
BACKGROUND: Wolcott-Rallison syndrome is an autosomal recessive, multisystem disorder with onset of diabetes in the neonatal period or early infancy. CASE REPORT: A 9-year-old girl with diabetes and growth failure from 2 months of age presented with ketoacidosis and multiple organ failure. Evaluation for short stature revealed epiphyseal dysplasia. A homozygous mutation in the EIF2AK3 gene confirmed the clinical diagnosis of Wolcott-Rallison syndrome. She was euthyroid...
March 2016: Diabetic Medicine: a Journal of the British Diabetic Association
C Sánchez-Marcos, V Hoffman, S Prieto-González, J Hernández-Rodríguez, G Espinosa
Renal tubular acidosis (RTA) is a rare complication of renal involvement of systemic lupus erythematosus (SLE). We describe a 24-year-old male with type IV lupus nephropathy as a presenting manifestation of SLE. He presented with improvement of renal function following induction therapy with three pulses of methylprednisolone and 500 mg biweekly pulses of cyclophosphamide. However, a week after the first pulse of cyclophosphamide, the patient presented with a significant increase in legs edema and severe hyperkalemia...
March 2016: Lupus
Ryan J Cornelius, Donghai Wen, Huaqing Li, Yang Yuan, Jun Wang-France, Paige C Warner, Steven C Sansom
A low Na, high K diet (LNaHK) is associated with a low rate of cardiovascular (CV) disease in many societies. Part of the benefit of LNaHK relies on its diuretic effects; however, the role of aldosterone (aldo) in the diuresis is not understood. LNaHK mice exhibit an increase in renal K secretion that is dependent on the large, Ca-activated K channel, (BK-α with accessory BK-β4; BK-α/β4). We hypothesized that aldo causes an osmotic diuresis by increasing BK-α/β4-mediated K secretion in LNaHK mice. We found that the plasma aldo concentration (P[aldo]) was elevated by 10-fold in LNaHK mice compared with control diet (Con) mice...
2015: PloS One
Daniella Bezerra Duarte, Lucas Alexandre Vanderlei, Raianne Kívia de Azevêdo Bispo, Maria Eliete Pinheiro, Geraldo Bezerra da Silva, Alice Maria Costa Martins, Gdayllon Cavalcante Meneses, Elizabeth De Francesco Daher
BACKGROUND: Renal involvement in Schistosoma mansoni infection is not well studied. The aim of this study is to investigate the occurrence of renal abnormalities in patients with hepatosplenic schistosomiasis (HSS), especially renal tubular disorders. METHODS: This is a cross-sectional study with 20 consecutive patients with HSS followed in a medical center in Maceió, Alagoas, Brazil. Urinary acidification and concentration tests were performed using calcium chloride (CaCl2) after a 12-h period of water and food deprivation...
2014: PloS One
Noritaka Kawada, Yoshitaka Isaka, Harumi Kitamura, Hiromi Rakugi, Toshiki Moriyama
HYPOTHESIS: This study determined the parameters for predicting the clinical effects of eplerenone (Ep) add-on therapy on blood pressure (BP) and proteinuria in patients taking angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II type I receptor blockers (ARBs). MATERIALS AND METHODS: Patients were treated with a gradual increase of Ep to a final dose of 50 mg/day for 2 months. In 35 patients, the efficacy of Ep was evaluated by peripheral BP, proteinuria, and the transtubular K gradient (TTKG)...
June 2015: Journal of the Renin-angiotensin-aldosterone System: JRAAS
Daniela Chlíbková, Beat Knechtle, Thomas Rosemann, Alena Žákovská, Ivana Tomášková
BACKGROUND: To assess the prevalence of exercise-associated hyponatremia (EAH) in two 24-hour mountain bike (MTB) (R1,R2), one 24-hour running (R3) and one multi-stage MTB (R4) races held in the Czech Republic in a cluster of four cross-sectional studies. METHODS: In 27 ultra-mountain bikers (ultra-MTBers), 12 ultra-runners, and 14 multi-stage MTBers, fluid intake, changes (Δ) in body mass, hematocrit, plasma volume, plasma [Na+], plasma [K+], plasma osmolality, urine [Na+], urine [K+], urine specific gravity, urine osmolality, K+/Na+ ratio in urine, transtubular potassium gradient and glomerular filtration rate were measured and calculated...
February 10, 2014: Journal of the International Society of Sports Nutrition
Geraldo B Silva Junior, Ana Patrícia F Vieira, Amanda X Couto Bem, Marília P Alves, Gdayllon C Meneses, Alice M C Martins, Talita R Sanches, Lúcia C Andrade, Antonio C Seguro, Alexandre B Libório, Elizabeth F Daher
BACKGROUND/AIMS: Kidney abnormalities are one of the main chronic complications of sickle cell disease (SCD). The aim of this study is to investigate the occurrence of renal tubular abnormalities among patients with SCD. METHODS: This is a prospective study with 26 SCD adult patients in Brazil. Urinary acidification and concentration tests were performed using calcium chloride (CaCl2), after a 12h period of water and food deprivation. Fractional excretion of sodium (FENa), transtubular potassium gradient (TTKG) and solute free water reabsorption (TcH2O) were calculated...
2013: Kidney & Blood Pressure Research
Roy Cho, Michele Leclaire, Robert Kempainen
OBJECTIVE: To describe a case of heparin-induced hyperkalemia and the role for transtubular potassium gradient (TTKG) to guide fludrocortisone therapy. CASE SUMMARY: A 52-year-old white male developed hyperkalemia after receiving intravenous unfractionated heparin (UFH) for atrial fibrillation during thyroid storm. Admission laboratory results were noteworthy for normal potassium levels, undetectable thyroid-stimulating hormone, and mild transaminitis. Treatment for thyroid storm was initiated but UFH was stopped because the international normalized ratio was subsequently found to be elevated...
September 2013: Annals of Pharmacotherapy
Lorenz Risch, Bernhard Hess
When it comes to interpret parameters of electrolyte balance and kidney function, it is important to keep pathophysiology and the theory on reference intervals in mind. Hyponatremia is most often caused by excess water. A low sodium concentration in urine should prompt a clinical evaluation of volume status. In case of suspected acute kidney failure, fractionated sodium excretion and fractionated urea excretion are able to provide insights on prerenal or renal origin of the disorder. Disruption in potassium homoeostasis can occur due to changes in supply or renal elimination as well as due to changes in the potassium balance between the extra- and intracellular compartments...
August 2013: Therapeutische Umschau. Revue Thérapeutique
Vidyut Bhatia, Anjali Dhawan, Narendra K Arora, Prashant Mathur, Manoja K Das, Mohammad Irshad
OBJECTIVES: The aim of the present study was to determine urinary potassium (K⁺) loss (as measured by fractional excretion of K⁺ [FEK] and transtubular K⁺ gradient [TTKG]) in children with acute liver failure (ALF) and acute viral hepatitis (AVH) at the time of presentation to the hospital and day 45 of follow-up. METHODS: Twenty-five patients with ALF and 84 patients with AVH were worked up for clinical features, liver function tests, and hepatitis viral infections and monitored for outcome...
July 2013: Journal of Pediatric Gastroenterology and Nutrition
Pieter M Jansen, Wijnanda J Frenkel, Bert-Jan H van den Born, Emile L E de Bruijne, Jaap Deinum, Michiel N Kerstens, Joyce H A Arnoldus, Arend Jan Woittiez, Johanna A M Wijbenga, Robert Zietse, A H Jan Danser, Anton H van den Meiracker
BACKGROUND: Add-on therapy with aldosterone receptor antagonists has been reported to lower blood pressure (BP) in patients with uncontrolled hypertension. We assessed potential predictors of this response. METHODS: In essential hypertensive patients with uncontrolled BP, despite the use of at least two antihypertensives, plasma renin and aldosterone concentrations and the transtubular potassium gradient (TTKG) were measured. Patients were treated with eplerenone 50 mg daily on top of their own medication...
February 2013: Journal of Hypertension
Takashi Shishido, Munekazu Ryuzaki, Koji Futatsugi, Chie Takimoto, Emi Kobayashi, Michiko Handa, Hiroshi Itoh
A 76-year-old man was admitted to our hospital because of severe anemia. Routine screening revealed a sigmoid adenocarcinoma, and he underwent sigmoidectomy. Post-operatively, he developed rapidly progressive glomerulonephritis. He was positive for myeloperoxidase anti-neutrophil cytoplasmic antibody. A renal biopsy revealed idiopathic crescentic glomerulonephritis of the pauci-immune type. He was treated with methylprednisolone semi-pulse therapy with clinical improvement. After the steroid pulse therapy, he was given oral prednisolone, 40 mg per day, and oral trimethoprim (TMP), 160 mg, and sulfamethoxazole (SMX), 800 mg twice weekly for chemoprophylaxis against pneumocystis pneumonia...
2012: Nihon Jinzo Gakkai Shi
Bunyong Phakdeekitcharoen, Chatchai Kreepala, Sarinya Boongird
BACKGROUND: Hypokalemia, serum potassium (K) < 3.5 mEq/L, is a serious and common clinical problem. The traditional diagnosis of renal potassium losses is 24-hr urine potassium (24U(K)) > or = 20 mEq/day during hypokalemia. Immediate replacement of potassium is often required to prevent complication but may normalize serum K during 24-hr urine collection and render the test inconclusive. MATERIAL AND METHOD: The authors examined the ability of urinary indices including 24U(K), transtubular potassium gradient (TTKG), fractional excretion of potassium (FE(K)), urine potassium-creatinine ratio (U(K/Cr)) and spot U(K) and introduced urine potassium per hour during the first 8 hours (U(K)/hr) as a novel index for evaluation of hypokalemia during treatment...
November 2011: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
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