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Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3 hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p <.001); SD (∼56%) was not different from SLM or W (p >.05). Net fluid balance was higher for SLM (−0.26 kg) and SD (−0.42 kg) than W (−0.67 kg) after 3 hr (p <.001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p >.05) despite ingestion of W (1,992 ± 425 ml), SD (1,999 ± 429 ml), and SLM (1,993 ± 426 ml) in 90 min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat. [ABSTRACT FROM AUTHOR]

Plantain (Plantago lanceolata L.) has recently been thrust into the limelight as a potential tool for mitigating nitrogen losses from the New Zealand pastoral environment. It is claimed to possess characteristics to reduce nitrogen leaching through both animal and soil-based mechanisms. This review examines the use of plantain in New Zealand pastures and the research that has led to these claims. The focus is on the evaluation of scientific evidence for the mechanisms through which plantain is proposed to reduce nitrate leaching, as well as the research on the implementation of plantain into pastoral farm systems. Plantain clearly increases the urination of grazing animals; a trait not unique to plantain. This review concludes that many research studies supporting the beneficial impact of plantain do not stand up against scientific scrutiny associated with methodology and interpretation of data. It is recommended more research should be undertaken on other pasture species and management tools, that may be more effective alternatives to plantain for nitrogen mitigation in pastures. [ABSTRACT FROM AUTHOR]

Évaluer les stratégies d'apports hydriques chez les prématurés de moins de 32 semaines en comparaison aux recommandations d'ESPGHAN de 2018. Étude rétrospective, descriptive allant du 1er juin 2022 au 31 juin 2023, portant sur 77 prématurés de moins de 32 semaines d'aménorrhées hospitalisés pendant au moins 15 jours. Les apports hydriques par voie entérale et parentérale étaient conformes aux recommandations d'ESPGHAN chez les moins de 1500 g et supérieurs chez les plus de 1500 g. Cependant, 52 (67 %) prématurés avaient une perte de poids non optimale dont 39 (51 %) avaient perdu plus de 10 % entre J2–J3 et 13 (17 %) ont perdu moins de 7 %. L'étude de la perte de poids en excluant l'alimentation entérale des apports hydriques avait noté que 30/52 prématurés avaient des apports hydriques inférieurs aux recommandations. Parmi eux, 23 prématurés qui avaient perdu plus de 10 % étaient caractérisés par une diurèse abondante, 7 cas de dysnatrémies et 7 prématurés ayant perdu moins de 7 % avaient une diurèse normale. En outre, 22/52 prématurés avaient des apports hydriques conformes aux recommandations d'ESPGHAN dont 16 avaient perdu plus de 10 % présentaient une diurèse abondante, 9 cas de dysnatrémies, 5 cas de macrosomies et 6 prématurés avec une perte de poids insuffisante présentaient une diurèse abondante, 2 cas RCIU. Les apports hydriques étaient inférieurs aux recommandations d'ESPGHAN chez plus de 50 % des prématurés avec une perte de poids non optimale en excluant l'alimentation entérale. Ces apports hydriques doivent être individualisés à chaque prématuré en fonction de la diurèse et de l'immaturité digestive. Cette perte de poids associait la macrosomie et le RCIU d'où l'étude de la composition corporelle de ses prématurés s'avère importante. Evaluate fluid intake strategies in premature infants under 32 weeks in comparison with the 2018 ESPGHAN recommendations. Retrospective, descriptive study from June 1st, 2022 to June 31st, 2023, involving 77 premature infants less than 32 weeks of amenorrhea hospitalized for at least 15 days. Fluid intake (enteral and parenteral) was consistent with recommendations in those under 1500 g and higher in those over 1500 g. However, 52 (67 %) premature babies had non-optimal weight loss, of which 39 (51 %) had lost more than 10 % between D2–D3 and 13 (17 %) lost less than 7 %. The study of weight loss by excluding enteral feeding from fluid intake noted that 30/52 premature infants had fluid intakes lower than recommendations. Among them, 23 premature infants who had lost more than 10 % were characterized by abundant diuresis, 7 cases of dysnatremia and 7 premature infants who had lost less than 7 % had normal diuresis. In addition, 22/52 premature infants had fluid intake consistent with ESPGHAN recommendations, 16 of whom had lost more than 10 %, had abundant diuresis, 9 cases of dysnatraemia, 5 cases of macrosomia and 6 premature infants with insufficient weight loss had abundant diuresis, 2 RCIU cases. Fluid intake was lower than ESPGHAN recommendations in more than 50 % of premature babies with non-optimal weight loss excluding enteral feeding. Its intake must be individualized for each premature baby according to diuresis and digestive immaturity. This weight loss associated macrosomia and IUGR, hence the study of the body composition of premature babies is important. [ABSTRACT FROM AUTHOR]

BACKGROUND Bladder dysfunction entails overactive bladder (OAB) defined as symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence if there is no obvious pathology or infection or lower urinary tract symptoms that includes recognized causes of bladder dysfunction. METHODS Literature search. RESULTS Symptoms of OAB are reported in about 15% of the adult US population. This is increased 2- to 3-fold in patients with congestive heart failure (CHF), hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), or the elderly where it often accompanies prescription for short, rapid-acting loop diuretics. However, less than 2% of patients seeking care for OAB receive treatment. The fear of urinary incontinence from short, rapid-acting loop diuretics may contribute to medication nonadherence and less well-controlled, apparently resistant hypertension. The bladder contracts to rapid stretch. Thus, less rapid-acting diuretics such as thiazides or extended-release formulations of loop diuretics may be preferable for those with bladder dysfunction. Alternatively, the use of a mineralocorticosteroid receptor antagonist, angiotensin receptor antagonist/neprilysin inhibitor, or sodium glucose-linked transport type 2 inhibitor may allow a reduction in the dose of a short, rapid-acting loop diuretic for those with bladder dysfunction. CONCLUSIONS A worsening of symptoms from bladder dysfunction by short, rapid-acting loop diuretics occurs frequently in patients with CVD, CHF, hypertension, and CKD where it can contribute to impaired quality of life and poor adherence and thereby to worsening outcomes. [ABSTRACT FROM AUTHOR]

Thiazide, thiazide-like, and loop diuretics are primarily known for inhibiting members of the SLC12A family of Cl- transporters, which include the Na+Cl- cotransporter (NCC), Na+K+2Cl- cotransporters (NKCC1 and NKCC2) and K+Cl- symporters (KCC1-4). While the main pharmacological effect of these diuretics is diuresis, achieved by promoting the excretion of excess water and salt through the kidneys, they have intriguing pharmacological effects beyond their traditional ones which cannot be solely attributed to their effects on renal salt transport. Of particular interest is their role in modulating inflammatory processes. These diuretics appear to exert both pro- and anti-inflammatory effects, potentially by influencing various pathways involved in immune responses. For example, NKCC1 has been implicated in the regulation of pro-inflammatory cytokines, such as interleukin-1β (IL1β), interleukin-8 (IL8) and tumor necrosis factor α (TNFα), which are critical mediators of immune cell activity during inflammation. The underlying mechanisms through which NKCC1 contributes to inflammation may involve key signaling pathways, such as that mediated by the nuclear factor kappa B (NFκB). This pathway is crucial for the activation and assembly of the inflammasome, as well as for regulating the phagocytic activity of immune cells. In addition, NKCC1 can control (or be controlled) by reactive oxygen species and oxidative stress, which contribute to the pathogenesis of various inflammatory conditions as well. Diuretics may help mitigate inflammation-related tissue damage by scavenging reactive oxygen species and boosting antioxidant defenses, thereby restoring redox balance in inflamed tissues. Despite these intriguing effects, the precise molecular pathways through which thiazide, thiazide-like and loop diuretics may modulate inflammatory responses remain poorly understood and warrant further investigation. This aspect of their pharmacological profile highlights their potential for therapeutic use beyond the scope of traditional diuretic functions. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. This was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous). Out of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %). HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration. [ABSTRACT FROM AUTHOR]

In patients with heart failure (HF) who respond inadequately to loop diuretic therapy, BMS‐986308, an oral, selective, reversible renal outer medullary potassium channel (ROMK) inhibitor may represent an effective diuretic with a novel mechanism of action. We present data from the first‐in‐human study aimed to assess the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) following single ascending doses of BMS‐986308 in healthy adult participants. Forty healthy participants, aged from 20 to 55 years, and body mass index (BMI) from 19.8 to 31.6 kg/m2 were assigned to 1 of 5 dose cohorts (1, 3, 10, 30, and 100 mg) and randomized (6:2) to receive BMS‐986308 oral solution or matching placebo. Following administration, BMS‐986308 was rapidly absorbed with a median time to maximum concentration (Tmax) of 1.00 to 1.75 h and exhibiting a mean terminal half‐life (t1/2) of approximately 13 h. Dose proportionality was evident in BMS‐986308 area under the concentration‐time curve (AUC), while maximum concentration (Cmax) was slightly greater than dose‐proportional. We observed that urine output (or diuresis; mL) and urinary sodium excretion (or natriuresis; mmol) increased in a dose‐dependent manner, starting at a minimum pharmacologically active dose of 30 mg. The largest mean changes from baseline in diuresis and natriuresis occurred in both the 6‐ and −24 h post‐dose period following administration of 100 mg (1683.0 mL and 2055.3 mL, and 231.7 mmol and 213.7 mmol, respectively; ***P < 0.001). Overall, single‐dose BMS‐986308 was found to be safe, well‐tolerated, with an excellent PK profile, and substantial diuretic and natriuretic activity. [ABSTRACT FROM AUTHOR]

Background: The current review aims to present the beneficial effects of SGLT2 inhibitors (dapagliflozin and empagliflozin) on several hemodynamic parameters such as blood pressure, filtration pressure at the level of the glomerular capillaries, and the improvement of the preload and afterload of heart muscle. In order to stop chronic kidney disease (CKD) from progressing, SGLT2 inhibitors have become an important disease-modifying treatment. Materials and methods: Recent clinical studies have shown the success of these drugs in treating heart failure, reducing the risk of cardiovascular events, hospitalization, and mortality. Results: The hemodynamic effects of SGLT2 inhibitors include a diuretic effect, due to reduced sodium reabsorption. Also, at this level, numerous studies have confirmed the beneficial effect of dapagliflozin in patients with chronic kidney disease, associated with a 44% reduced risk of progression in this pathology. SGLT2 inhibitors are associated with a reduction in blood pressure and weight loss, because of their diuretic effect, especially empagliflozin, which can explain the beneficial effects in patients with heart failure. In addition, mainly empagliflozin reduces stiffness and arterial resistance. Conclusions: Although the exact mechanism of action is unknown, SGLT2 inhibitors reduce the interstitial volume by blocking the tubular reabsorption of glucose. This leads to reduced blood pressure and enhanced endothelial function. Consequently, there have been improvements in hospitalization and fatality rates. Because of their beneficial effects, these medications have been guidelines for managing heart failure and chronic kidney disease. [ABSTRACT FROM AUTHOR]

Abstract Aims Diuretic resistance (i.e., insufficient diuretic and natriuretic response to an appropriate dose of intravenously administered loop diuretic) is a major cause of insufficient decongestion in acute heart failure (AHF). Early assessment of diuretic and natriuretic response already after the first administration of loop diuretic is currently recommended, but few data exist on the prevalence and characteristics of upfront diuretic resistance in AHF. The aim of this sub‐study of the P‐Value‐AHF randomized clinical trial was to investigate the prevalence and characteristics of upfront diuretic resistance in patients presenting with AHF in the emergency department (ED). Methods Consecutive patients presenting with a clinical diagnosis of AHF, ≥1 sign of congestion, and NT‐proBNP >1000 ng/L between February and June 2024 were prospectively screened. Loop diuretics were administered per protocol: 40 mg furosemide i.v. in diuretic‐naïve patients and those on oral torasemide

Introduction: Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age (GA), are missing. Methods: This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants. Results: VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 mL/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGANs), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants. Conclusion: UOP is dynamic in the postnatal period and differs significantly between GA cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants. [ABSTRACT FROM AUTHOR]

The targeted activation or inhibition of specific cell populations using chemogenetics allows the precise dissection of cellular signaling and function. Designer receptors exclusively activated by designer drugs (DREADDs) is a chemogenetic platform initially developed by mutating human muscarinic receptors to be unresponsive to endogenous acetylcholine but exclusively activated by an "inert" designer drug. Compound 21 (C21) is a new and potent DREADD agonist; however, radioligand assays from a recent report indicated its ability to bind to endogenous G protein-coupled receptors (GPCRs), including muscarinic M1–3 receptors. Whether this binding causes off-target effects is unclear. Renal innervation is important for the regulation of renal function, and the advent of chemogenetic tools provides significant opportunities for the mechanistic understanding of renal innervation and function. GPCRs such as adrenergic and muscarinic receptors play a role in renal function; thus, a careful pharmacological characterization of C21 in renal function is a prerequisite for this approach. Unexpectedly, an infusion of 1.0 mg/kg C21 in anesthetized mice caused an ∼4-fold increase in urine output and correspondingly increased the glomerular filtration rate (GFR), suggesting a C21-mediated acute diuretic effect. This acute diuresis effect was further confirmed in awake mice using voiding spot assays. The exact molecular mechanism for C21-mediated diuresis is unclear; however, we demonstrated by in vitro myography that C21 can effectively inhibit bladder smooth muscle contraction by antagonizing M3 receptors at the micromolar level, causing increased voiding size in vivo. In summary, C21 functions as a GPCR antagonist and has significant dose-dependent off-target effects in the renal system. [ABSTRACT FROM AUTHOR]

Background: Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method. Aim: This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia. Study Design: This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT‐related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t‐tests before and after CRRT. Results: After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p =.005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS. Conclusion: It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff. Relevance to Clinical Practice: The sterile water‐based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT‐trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Solanum sisymbriifolium Lam. is a native perennial plant with chemical characteristics of therapeutic importance. In Paraguayan traditional medicine, it is attributed to antihypertensive and diuretic activities. For this reason, the objective of the study was to evaluate the effect of acute oral administration of the ethanolic extract and fraction enriched in saponins obtained from the root of S. sisymbriifolium on the diuresis profile of rats. MATERIALS AND METHODS: Male Wistar rats were used, randomly distributed in 6 groups to evaluate the diuretic activity. The control group received distilled water; the diuretic group was treated with 20 mg/kg of furosemide. Two groups were treated with 50 and 100 mg/kg of the ethanolic extract of S. sisymbriifolium, and two other groups were treated with 1 and 10 mg/kg with the fraction enriched in saponins. The animals were placed in individual metabolic cages for a period of 24 h. Urine volume was determined at 5 and 24 h, and urinary electrolytes, pH, and glomerular filtration rate at 24 h. RESULTS: The findings indicated that both doses of the ethanolic extract and the saponin-enriched fraction significantly increased diuresis after 24 hours of treatment. Urinary pH was not affected. A significant increase in the urinary excretion of Na+ and Cl- was observed without affecting the elimination of K+ with both doses of the extracts. In addition, a significant increase in GFR was evidenced. CONCLUSIONS: Both ethanolic extract and saponins enriched fraction, presented natriuretic and saluretic effects with a possible mechanism of action mediated, at least partially, by the inhibition of carbonic anhydrase. Furthermore, it was possible to demonstrate the participation of the COX/PG pathway in the diuretic mechanism of the extracts in male rats. [ABSTRACT FROM AUTHOR]

Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple approaches have been tried to achieve adequate decongestion rapidly while minimizing adverse effects, no single diuretic strategy has shown superiority, and there is a paucity of data and guidelines to utilize in making these decisions. Observational cohort studies have shown associations between urine sodium excretion and outcomes after hospitalization for ADHF. Urine chemistries (urine sodium ± urine creatinine) may guide diuretic titration during ADHF, and multiple randomized clinical trials have been designed to compare a strategy of urine chemistry–guided diuresis to usual care. This review will summarize current literature for diuretic monitoring and titration strategies, outline evidence gaps, and describe the recently completed and ongoing clinical trials to address these gaps in patients with ADHF with a particular focus on the utility of urine sodium–guided strategies. [ABSTRACT FROM AUTHOR]

World Health Organization (WHO) estimates that 12% of the world's population suffers from urolithiasis, a disorder that causes stones to develop in the kidney, bladder, and/or urethra (the urinary system). The illness increases the likelihood of developing chronic renal illnesses in addition to impairing kidney function. Three phases make up the mechanism for the production of stones: nucleation, growth, and aggregation of crystals. Because of their medicinal and antioxidant properties, as well as their active substances, medicinal plants have positive benefits on human health. The traditional medicinal herbs' diuretic qualities are increasingly being backed by scientific research. Urinary calculi patients complain of hematuria, discomfort, or infection. Individuals with tiny, non-obstructing stones or staghorn calculi have moderate, easily managed symptoms in addition to other symptoms. The illness increases the likelihood of developing chronic renal illnesses in addition to impairing kidney function. Therefore, a plant's or a herbal formulation's antiurolithiatic effect may be the result of a combination of its antioxidant, diuretic, and crystallization-inhibiting properties. [ABSTRACT FROM AUTHOR]

The deposition of hard crystals created by mineral or salt buildup in the urine canal leads to kidney stones, a frequent urinary tract issue. Urine flow obstruction and excruciating discomfort can be caused by kidney stones. Numerous processes can lead to oxidative stress, which raises the probability of kidney stones developing. The inflammatory response that results from kidney stones forming exacerbates oxidative stress further, creating a vicious cycle. This urological condition, which affects both male and female populations, is becoming more widespread worldwide. Planning the volume of urine produced is a crucial stage in the elimination of kidney stones. Surgery such as shock wave lithotripsy (SWL) and ureteroscopy (URS) is used to treat conditions when the stone has ceased passing through and is causing excruciating discomfort. Because of their medicinal and antioxidant properties, as well as their active substances, medicinal plants have positive benefits on human health. Regrettably, end-stage renal disease is frequently the consequence of side effects brought on the traditional medications used to treat nephrolithiasis. Kidney stones can be avoided by controlling nutrition intake, medication usage, and diet. Agents that are urolithotriptic are medicinal herbs. Examining the natural plants that are utilized to treat the illness is the goal of this review. Finding natural plants that can be used to cure kidney stones was made easier by this review. [ABSTRACT FROM AUTHOR]

Background: Positron emission tomography (PET) with 18F-FDG is being used more frequently to evaluate primary pelvic tumors (PTs). However, a standardized hydration protocol is essential for an optimal diuretic effect and constant results. Methods: We reviewed 109 patients with PTs who had undergone 18F-FDG PET/CT examinations between November 2006 and April 2013. Four different protocols were used: (a) no hydration (group 1); (b) oral hydration (800 mL) after an early scan (group 2); (c) intravenous (IV) hydration (500 mL) during an early scan followed by oral hydration (800 mL) and IV furosemide (20 mg) after an early scan (group 3); and (d) oral hydration (800 mL) before an FDG injection followed by the protocol from group 3 (group 4). The maximum standardized uptake (SUVmax) of the urinary bladder (UB) and PTs and the PT/UB SUVmax ratios were examined. Results: The UB SUVmax of group 4 was significantly lower in the early scan compared to that in the other three groups. Group 4 had a significantly higher PT/UB SUVmax ratio in the early scan than the other three groups, and it also had a 52.5% positivity rate for PTs. Conclusions: The pre-hydration plus forced diuresis protocol yielded the optimal effect of UB radiotracer washout and had the best PT/UB SUVmax ratio in both scans. [ABSTRACT FROM AUTHOR]

Late graft thrombosis is an infrequent yet severe complication post renal transplantation, profoundly affecting graft survival and patient prognosis. We report a case of a 29-year-old male with end-stage renal disease due to IgA nephropathy who underwent ABO-incompatible renal transplantation. Despite effective desensitization, the patient experienced late graft thrombosis 3 months posttransplant, resulting in irreversible graft failure and necessitating hemodialysis initiation. This case underscores the complexities of late graft thrombosis and emphasizes the significance of timely identification and intervention for optimizing transplant outcomes. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a multifactorial syndrome with a high risk of short- and long-term complications as well as increased health care costs. The traditional biomarkers of AKI, serum creatinine and urine output, have important limitations. The discovery of new functional and damage/stress biomarkers has enabled a more precise delineation of the aetiology, pathophysiology, site, mechanisms, and severity of injury. This has allowed earlier diagnosis, better prognostication, and the identification of AKI sub-phenotypes. In this review, we summarize the roles and challenges of these new biomarkers in clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms (LUTSs) are a common complaint in adult and elderly men with bladder outlet obstruction, and have a considerable impact on their quality of life. Symptoms affect storage, voiding and post micturition stages. Among the latter, a feeling of incomplete emptying is one of the most bothersome for the patients; a condition that in turn contributes to affect urinary urgency, nocturia and frequency. Common recommendations include self-management practices (e.g., control of fluid intake, double-voiding and distraction techniques) to relieve patients' symptoms, whose effectiveness, however, is under debate. Methods: In this report we describe two pioneering procedures to favor bladder residual content voiding in people complaining of LUTS disorders. The first is based on motor imagery and the second on the use of odors. The beneficial effects of Mental imagery techniques on various tasks (e.g., in the treatment of several pathological conditions or as valid mnemonics aids have a long tradition and have received consistently experimental support. Thus, a patient (a 68-year-old Caucasian man) complaining of LUTS was trained to use a motor imagery technique (building up a visual image comprising the bladder, the detrusor muscle and the urethra, and to imagine the detrusor muscle contracting and the flow of urine expelled) for 90 days and two odors (coffee and a lavender scented cleanser) for 10 days, as a trigger for micturition. He was asked to record—immediately after the first morning micturition—the time interval between the first (free) and the second (cued) micturition. Results: Reported data suggest the efficacy of motor imagery in favoring the bladder residual urine voiding in a few minutes (M = 4.75 min.) compared to the control condition, i.e., the baseline of the patient (M = 79.5 min.), while no differences between the odor-based procedures (M 1st odorant = 70.6 min.; M 2nd odorant = 71.1 min) and the latter were observed. Conclusions: A procedure based on an imagery technique may, therefore, be of general value—as a suggested protocol—and accordingly can be applicable to clinical settings. An olfactory bladder control hypothesis cannot, however, be ruled out and is discussed as a promising future line of research. [ABSTRACT FROM AUTHOR]

Houttuynia cordata is an important traditional Chinese medicine. It is widely used for clearing heat and detoxification, reducing swelling and treating sores, diuresis and dehumidification. It is also used to treat lung carbuncles, ulcers, hemorrhoids, rectal bleeding, spleen and stomach heat, which are caused by excess heat, heat toxicity, dampness, and disease heat. Modern pharmacological experiments have shown that H. cordata has antibacterial, antiviral, immune enhancing, diuretic and other effects. This article reviews the chemical components and biological activities of H. cordata to provide reference for clinical application. [ABSTRACT FROM AUTHOR]

Acute heart failure (AHF) often leads to unfavorable outcomes due to fluid overload. While diuretics are the cornerstone treatment, acetazolamide may enhance diuretic efficiency by reducing sodium reabsorption. We performed a systematic review and meta-analysis on the effects of acetazolamide as an add-on therapy in patients with AHF compared to diuretic therapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCT). A random-effects model was employed to compute mean differences and risk ratios. Statistical analysis was performed using R software. The GRADE approach was used to rate the certainty of the evidence. We included 4 RCTs with 634 patients aged 68 to 81 years. Over a mean follow-up of 3 days to 34 months, acetazolamide significantly increased diuresis (MD 899.2 mL; 95% CI 249.5 to 1549; p < 0.01) and natriuresis (MD 72.44 mmol/L; 95% CI 39.4 to 105.4; p < 0.01) after 48 h of its administration. No association was found between acetazolamide use and WRF (RR 2.4; 95% CI 0.4 to 14.2; p = 0.3) or all-cause mortality (RR 1.2; 95% CI 0.8 to 1.9; p = 0.3). Clinical decongestion was significantly higher in the intervention group (RR 1.35; 95% CI 1.09 to 1.68; p = 0.01). Acetazolamide is an effective add-on therapy in patients with AHF, increasing diuresis, natriuresis, and clinical decongestion, but it was not associated with differences in mortality. [ABSTRACT FROM AUTHOR]

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer's lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer's lactate. A P -value<0.05 was considered significant. The primary endpoint of this study is renal function. Results: Demographic characteristics and risk factors were not significantly different between the two groups (P >0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P >0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P =0.53) or BUN levels (P =0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P =0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery. [ABSTRACT FROM AUTHOR]

Ilaj bit Tadbeer, a vital therapeutic approach in the Unani system of medicine, focuses on modifying six essential elements to restore health. This approach encompasses various regimenal therapies such as cupping (Hijāma), leeching (Ta'līq or irsal-e- 'Alaq), venesection (Fasd), massage (Dalk), irrigation (Natūl), emesis (Qay'), diuresis (Idrār-i-Bawl), diaphoresis (Tariq), concoction and purgation (Mundij and Mu'shil therapy), medicated steam (Bukhoor), cauterization (Kaiyy), and enema (Huqna). Fasd is a crucial regimen in Ilaj Bit Tadbeer, serving as a method to eliminate morbid material from the body to treat diseases or maintain good health. With a history of almost 3000 years, Fasd has been effectively utilized in treating various ailments across different eras. Although venesection, or Fasd, has a historical significance, its modern application has declined due to the lack of scientific validation. This review aims to explore the historical context, therapeutic applications, contraindications, and contemporary scientific evidence of Fasd, emphasizing its potential in modern medicine. [ABSTRACT FROM AUTHOR]

The purpose of the present study is to investigate the effect of aqueous and methanolic extracts of Grewia flavescens (AEGF and MEGF respectively) on kidney stones using in vitro and in vivo methods. In vitro anti-urolithiasis activity was performed by different assays like nucleation, crystal growth, crystal aggregation, and crystal dissolution assays were performed and cell viability studies were performed on the MDCK cell line before and after exposure to oxalate. An HPTLC and HPLC method was developed for the quantification of diosgenin, catechin, rutin, gallic acid, and quercetin in extract. For an in vivo study, performed a diuretic activity model and sodium oxalate-induced urolithiasis in male Wistar albino rats. Determination of body and kidney weight, measurement of various biochemical parameters in biological samples, and examination of histology of the kidney at the end of the experiment were also done. AEGF and MEGF exhibited a concentration-dependent inhibitory activity on nucleation and aggregation along with a decreased number of calcium oxalate crystals produced in calcium oxalate metastable solutions in the in vitro experiments. Cell line study showed that extracts showed cell viability in the presence of oxalate. Co-administration of AEGF and MEGF with sodium oxalate has significantly (p

Introduction: Accurate volume status monitoring is crucial for effective diuretic therapy in patients with acute decompensated heart failure (ADHF). While guidelines recommend daily standing body weight measurement as an indicator of volume status, bed scales are commonly used in healthcare facilities. Methods: A method-comparison design was used to compare bed and standing scale weights among adults hospitalized with ADHF at Los Angeles County–University of Southern California Medical Center between March and April 2023. Results & Conclusion: Among 51 weight pairs from 43 participants, a clinically significant mean difference of 1.42 ± 1.18 kg was observed, exceeding the recommended threshold. Inaccuracies, with 71% showing differences >0.6 kg, highlight potential fluid management errors when relying on bed scales in ADHF hospitalizations. Article highlights Heart failure affects 6.5 million Americans, with acute decompensated heart failure causing over 1 million annual inpatient admissions with significant healthcare costs. Accurate weight measurement is essential in determining a patient's volume status and titrating diuresis, a mainstay of therapy, in order to reduce hospitalization duration and prevent readmission. Guidelines recommend daily monitoring of standing body weight, though many hospitals use bed scales instead. This study compared weights obtained via bed and standing scales among patients hospitalized with acute decompensated heart failure. Bed scale weights were inaccurate compared with standing scale weights, with a mean difference of 1.42 ± 1.18 kg (95% CI: -0.894 to 3.73), exceeding the recommended threshold. Factors contributing to inaccuracies include inadequate bed calibration and the presence of extra items during in-bed weighing. Inaccuracies in bed scale weights highlight the need for reform in this current standard practice of care in order to avoid potential errors in medical management, reduce readmission, and facilitate the self-monitoring of patients' weights at home. [ABSTRACT FROM AUTHOR]

Daylily (Hemerocallis citrina) is a perennial herb of the genus Hemerocallis of Liliaceae. It is also an economically important crop and is widely cultivated. Daylily has nutritional, medicinal and ornamental values. The research literature shows that daylily is a high-quality food raw material rich in soluble sugars, ascorbic acid, flavonoids, dietary fiber, carotenoids, mineral elements, polyphenols and other nutrients, which are effective in clearing heat and diuresis, resolving bruises and stopping bleeding, strengthening the stomach and brain, and reducing serum cholesterol levels. This article reviews the main nutrients of daylily and summarizes the drying process of daylily. In addition, due to the existence of active ingredients, daylily also has a variety of biological activities that are beneficial to human health. This article also highlights the nutritional quality of daylily, the research progress of dried vegetable rehydration technology and dried daylily. In the end, the undeveloped molecular mechanism and functional research status of daylily worldwide are introduced in order to provide reference for the nutritional quality research and dried processing industry of daylily. [ABSTRACT FROM AUTHOR]

Introduction We tested the hypothesis that a carbohydrate (CHO: 6.5%) or carbohydrate–electrolyte (CHO + E: 6.5% + 50 mmol/L NaCl) drink would better recover plasma volume (PV) and exercise performance compared to water (H2O) after immersion diuresis. Methods Twelve men (24 ± 2 years; 82.4 ± 15.5 kg; and V̇O2max: 49.8 ± 5.1 mL · kg−1 · min−1) completed four experimental visits: a no-immersion control (CON) and three 4-h cold-water (18.0 °C) immersion trials (H2O, CHO, and CHO + E) followed by exercise in a warm environment (30 °C, 50% relative humidity). The exercise was a 60-minute loaded march (20.4 kg; 55% VO2max) followed by a 10-minute intermittent running protocol. After immersion, subjects were rehydrated with 100% of body mass loss from immersion diuresis during the ruck march. PV is reported as a percent change after immersion, after the ruck march, and after the intermittent running protocol. The intermittent running protocol distance provided an index of exercise performance. Data are reported as mean ± SD. Results After immersion, body mass loss was 2.3 ± 0.7%, 2.3 ± 0.5%, and 2.3 ± 0.6% for H2O, CHO, and CHO + E. PV loss after immersion was 19.8 ± 8.5% in H2O, 18.2 ± 7.0% in CHO, and 13.9 ± 9.3% in CHO + E, which was reduced after the ruck march to 14.7 ± 4.7% (P  = .13) in H2O, 8.8 ± 8.3% (P  < .01) in CHO, and 4.4 ± 10.9% (P  = .02) in CHO + E. The intermittent running protocol distance was 1.4 ± 0.1 km in CON, 1.4 ± 0.2 km in H2O, 1.4 ± 0.1 km in CHO, and 1.4 ± 0.2 km in CHO + E (P  = .28). Conclusions Although CHO and CHO + E better restored PV after immersion, post-immersion exercise performance was not augmented compared to H2O, highlighting that fluid replacement following immersion diuresis should focus on restoring volume lost rather than fluid constituents. [ABSTRACT FROM AUTHOR]

Understanding the function of the kappa opioid receptor (KOP) is crucial for the development of novel therapeutic interventions that target KOP for the treatment of pain, stress‐related disorders and other indications. Activation of KOP produces diuretic effects in rodents and man. Sex is a vital factor to consider when assessing drug response in pre‐clinical and clinical studies. In this study, the diuretic effect of the KOP agonist, U50488 (1–10 mg/kg), was investigated in both adult female and male Wistar rats that were either normally hydrated or water‐loaded. The KOP antagonist norbinaltorphimine (norBNI, 10 mg/kg) was administered 24 h prior to U50488 to confirm the involvement of KOP. U50488 elicited a significant diuretic response at doses ≥ 3 mg/kg in both female and male rats independent of hydration status. U50488 diuretic effects were inhibited by norBNI pre‐administration. Water‐loading reduced data variability for urine volume in males, but not in females, compared with normally hydrated rats. Sex differences were also evident in U50488 eliciting a significant increase in sodium and potassium ion excretion only in males. This may suggest different mechanisms of U50488 diuretic action in males where renal excretion mechanisms are directly affected more than in females. [ABSTRACT FROM AUTHOR]

Background: The first uninterrupted sleep period (FUSP, time up to the first episode of enuresis/nocturia after falling asleep) is a frequently investigated parameter in adults with nocturia, as it correlates with quality of life. However, it has not been included in pediatric enuresis studies. Aim: Investigate FUSP, circadian renal water and sodium handling, as well as sleep quality before and after desmopressin therapy in enuresis. Materials and Methods: We conducted a post hoc analysis of a prospective study in 30 treatment‐naïve children with enuresis who underwent a video‐polysomnography and a 24‐h urine concentration profile before and after 6 months of desmopressin therapy. We analyzed FUSP, periodic limb movements in sleep (PLMS), and arousal indexes and their correlations with the urinary parameters. Results: Sixteen children with a mean age of 10.9 ± 3.1 years had full registrations and were included in this subanalysis. After therapy, FUSP was significantly longer (p < 0.001), and the PLMS index was lower (p = 0.023). Significant differences in the circadian rhythm of diuresis (night/day diuresis, p = 0.041), nocturnal urinary osmolality (p = 0.009), and creatinine (p = 0.001) were found, demonstrating the increase of urinary concentration overnight by desmopressin, as well as a significant antidiuretic effect (diuresis [p = 0.013] and diuresis rate (p = 0.008). There was no correlation between the difference of FUSP, PLMS index, and urinary parameters. Nevertheless, despite this study being underpowered, there are indications of a correlation between nocturnal diuresis and diuresis rate. Results: Our results support the need for further research regarding FUSP in children with enuresis, in accordance with nocturia studies in adults, as this parameter could be valuable in the follow‐up and evaluation of therapeutic strategies for enuresis. [ABSTRACT FROM AUTHOR]

Introduction: This article delves into the intricate relationship between kidney function, diuresis, and lower urinary tract symptoms (LUTS) throughout the transitions of the human lifespan. It explores circadian regulation of urine production, maturation of renal function from birth to adulthood, and effects of aging on kidney function and LUTS. The complex connections between these factors are highlighted, offering insights into potential interventions and personalized management strategies. Methods: An international panel of seven experts engaged in online discussions, focusing on kidney function, diuresis, and LUTS throughout life. This manuscript summarizes expert insights, literature reviews, and findings presented during a webinar and subsequent discussions. Results: Renal function undergoes significant maturation from birth to adulthood, with changes in glomerular filtration rate, diuresis, and tubular function. A circadian rhythm in urine production is established during childhood. Adolescents and young adults can experience persistent enuresis due to lifestyle factors, comorbidities, and complex physiological changes. In older adults, age‐related alterations in kidney function disrupt the circadian rhythm of diuresis, contributing to nocturnal polyuria and LUTS. Conclusion: The interplay between kidney function, diuresis, and LUTS is crucial in understanding lifelong urinary health. Bridging the gap between pediatric and adult care is essential to address enuresis in adolescents and young adults effectively. For older adults, recognizing the impact of aging on renal function and fluid balance is vital in managing nocturia. This holistic approach provides a foundation for developing innovative interventions and personalized treatments to enhance quality of life for individuals with LUTS across all stages of life. [ABSTRACT FROM AUTHOR]

The purpose of the present study is to investigate the effect of aqueous and methanolic extracts of Grewia flavescens (AEGF and MEGF respectively) on kidney stones using in vitro and in vivo methods. In vitro anti-urolithiasis activity was performed by different assays like nucleation, crystal growth, crystal aggregation, and crystal dissolution assays were performed and cell viability studies were performed on the MDCK cell line before and after exposure to oxalate. An HPTLC and HPLC method was developed for the quantification of diosgenin, catechin, rutin, gallic acid, and quercetin in extract. For an in vivo study, performed a diuretic activity model and sodium oxalate-induced urolithiasis in male Wistar albino rats. Determination of body and kidney weight, measurement of various biochemical parameters in biological samples, and examination of histology of the kidney at the end of the experiment were also done. AEGF and MEGF exhibited a concentration-dependent inhibitory activity on nucleation and aggregation along with a decreased number of calcium oxalate crystals produced in calcium oxalate metastable solutions in the in vitro experiments. Cell line study showed that extracts showed cell viability in the presence of oxalate. Co-administration of AEGF and MEGF with sodium oxalate has significantly (p<0.001) increased the urine volume and the level of calculus inhibitors and decreased the level of calculus promoters. HPTLC and HPLC data showed that extracts contain catechin, rutin, gallic acid, and quercetin. These results data indicate that AEGF and MEGF showed significant activity in urolithiasis which might be due to their diuretic, crystal formation inhibitory effects and their ability to increase the levels of inhibitors and decrease the level of promoters of urolithiasis due to the presence of active constituents in extracts. [ABSTRACT FROM AUTHOR]

The targeted activation or inhibition of specific cell populations using chemogenetics allows the precise dissection of cellular signaling and function. Designer receptors exclusively activated by designer drugs (DREADDs) is a chemogenetic platform initially developed by mutating human muscarinic receptors to be unresponsive to endogenous acetylcholine but exclusively activated by an “inert” designer drug. Compound 21 (C21) is a new and potent DREADD agonist; however, radioligand assays from a recent report indicated its ability to bind to endogenous G protein-coupled receptors (GPCRs), including muscarinic M1–3 receptors. Whether this binding causes off-target effects is unclear. Renal innervation is important for the regulation of renal function, and the advent of chemogenetic tools provides significant opportunities for the mechanistic understanding of renal innervation and function. GPCRs such as adrenergic and muscarinic receptors play a role in renal function; thus, a careful pharmacological characterization of C21 in renal function is a prerequisite for this approach. Unexpectedly, an infusion of 1.0 mg/kg C21 in anesthetized mice caused an ∼4-fold increase in urine output and correspondingly increased the glomerular filtration rate (GFR), suggesting a C21-mediated acute diuretic effect. This acute diuresis effect was further confirmed in awake mice using voiding spot assays. The exact molecular mechanism for C21-mediated diuresis is unclear; however, we demonstrated by in vitro myography that C21 can effectively inhibit bladder smooth muscle contraction by antagonizing M3 receptors at the micromolar level, causing increased voiding size in vivo. In summary, C21 functions as a GPCR antagonist and has significant dose-dependent off-target effects in the renal system.

Abstract Background Alpha2-adrenoceptor agonists (α2-agonists) are widely used in animals as sedatives and for pre-anaesthetic medication. Medetomidine has often been given subcutaneously (SC) to rats, although its absorption rate is slow and the individual variation in serum drug concentrations is high via this route. In addition, α2-agonists have various effects on metabolic and endocrine functions such as hypoinsulinaemia, hyperglycaemia and diuresis. Vatinoxan is a peripherally acting α2-adrenoceptor antagonist that, as a hydrophilic molecule, does not cross the blood-brain barrier in significant quantities and thus alleviates peripheral cardiovascular effects and adverse metabolic effects of α2-agonists. Aim of this study was to evaluate the effects of vatinoxan on sedation, blood glucose concentration, voiding and heart and respiratory rates and arterial oxygen saturation in rats sedated with subcutaneous medetomidine, midazolam and fentanyl. Results Onset of sedation and loss of righting reflex occurred significantly faster with vatinoxan [5.35 ± 1.08 (mean ± SD) versus 12.97 ± 6.18 min and 6.53 ± 2.18 versus 14.47 ± 7.28 min, respectively]. No significant differences were detected in heart and respiratory rates and arterial oxygen saturation between treatments. Blood glucose concentration (18.3 ± 3.6 versus 11.8 ± 1.2 mmol/L) and spontaneous urinary voiding [35.9 (15.1–41.6), range (median) versus 0.9 (0–8.0) mL /kg/min] were significantly higher without vatinoxan. Conclusions Acceleration of induction of sedation, alleviation of hyperglycaemia and prevention of profuse diuresis by vatinoxan may be beneficial when sedating rats for clinical and experimental purposes with subcutaneous medetomidine, midazolam and fentanyl.

Abstract Background This study evaluates the association of diuresis and hydration through a new monitoring indicator called $${U}_{sen}$$ U sen and the risk of acute kidney injury in patients treated with cisplatin based-EXTREME regimen. Methods We retrospectively reviewed all the cycles of patients with recurrent and/or metastatic head and neck cancer who received cisplatin based-EXTREME regimen from June 2008 to July 2022. Hydration regimen, urine output and concomitant treatments data were collected on the day of cisplatin infusion and the following day of each course received. Results Of the 110 courses received by 46 patients, 38 (34.5%) results in AKI. No patient characteristics showed a significant difference between AKI (70%) and non-AKI (30%) group. In univariate analysis, dose reduction of cisplatin (odds ratio = 0.166 [0.04; 0.75], p = 0.01)) and $${U}_{sen}$$ U sen >8 (odds ratio = 0.316 [0.133; 0.755], p = 0.015) and cardiac treatments (odds ratio = 3.24 [1.26; 8.52], p = 0.02) were significantly associated with AKI risk. In multivariate analysis, cisplatin dose reduction (odds ratio = 0.129 [0.0241; 0.687], p = 0.016) and $${U}_{sen}$$ U sen >8 (odds ratio = 0.184 [0.0648; 0.523], p = 0.0015) were associated with a risk reduction of cisplatin-related AKI. Concomitant administration of cardiac treatments (odds ratio = 3.18 [1.1; 9.22], p = 0.033) showed an increased risk of cisplatin-related AKI. Conclusion The combination of diuresis and i.v. hydration through the $${U}_{sen}$$ U sen composite score was shown to be associated with cisplatin-induced AKI risk in patients treated with cisplatin based EXTREME regimen. It could be used as a practical indicator to trigger specific clinical management to limit the risk of cisplatin induced AKI.

Nardos Lema Wondimu,1,&ast; Mestayet Geta Mengistie,2,&ast; Jibril Seid Yesuf2,&ast; 1Department of Pharmacy, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia; 2Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia&ast;These authors contributed equally to this workCorrespondence: Nardos Lema Wondimu, Tel +251910540868, Email nardoslema123@gmail.comPurpose: To evaluate the diuretic effects of aqueous (AQ) and hydromethanolic crude extract (HM) the as well as the solvent fractions of the HM extract from Erica arborea flowers in mice.Methods: Mice were administered AQ and HM crude extracts, along with solvent fractions of HM extracts of E. arborea flowers, including HXF (n-hexane fraction), EAF (ethyl acetate fraction), and AQF (aqueous fraction), at doses ranging from 100 to 400 mg/kg orally. The effects of these extracts and solvent fractions on urine and salt excretion over 5 hours were compared to the effects of the solvent used for reconstitution and a standard drug (furosemide 10 mg/kg), as well as to each other.Results: The HM crude extract at a lower dose (100 mg/kg) significantly increased urine volume and salt excretion starting from the 3rd h compared to the AQ crude extract. Similar effects were observed for EAF. Notably, the HM extract and its EAF at 400 mg/kg showed comparable urine and salt excretion profiles to the standard drug.Conclusion: This study demonstrated that HM extract and EAF promote better diuresis, likely due to their saluretic properties. Furthermore, it confirms the diuretic activity of Erica arborea flowers.Keywords: diuresis, natriuresis, urine electrolyte, urine pH, mice

Nephrogenic diabetes insipidus is a heterogeneous disease in the etiopathogenesis of which are involved acquired and congenital factors. In this case, the kidneys do not respond to vasopressin and continue to produce large concentrated volumes of urine. Distinctive features in the pathology of central genesis are the fact of trauma, brain tumor with involvement of pituitary gland, response to intranasal vasopressin in the form of decreased diuresis.For diagnosis it is important to perform a series of differential diagnostic tests.In this article we present a unique clinical case of a patient with a long-term course of diabetes insipidus with the development a spectrum of comorbid conditions, metabolic disorders, required kidney transplantation.

Background: Alpha2-adrenoceptor agonists (α2-agonists) are widely used in animals as sedatives and for pre-anaesthetic medication. Medetomidine has often been given subcutaneously (SC) to rats, although its absorption rate is slow and the individual variation in serum drug concentrations is high via this route. In addition, α2-agonists have various effects on metabolic and endocrine functions such as hypoinsulinaemia, hyperglycaemia and diuresis. Vatinoxan is a peripherally acting α2-adrenoceptor antagonist that, as a hydrophilic molecule, does not cross the blood-brain barrier in significant quantities and thus alleviates peripheral cardiovascular effects and adverse metabolic effects of α2-agonists. Aim of this study was to evaluate the effects of vatinoxan on sedation, blood glucose concentration, voiding and heart and respiratory rates and arterial oxygen saturation in rats sedated with subcutaneous medetomidine, midazolam and fentanyl. Results: Onset of sedation and loss of righting reflex occurred significantly faster with vatinoxan [5.35 ± 1.08 (mean ± SD) versus 12.97 ± 6.18 min and 6.53 ± 2.18 versus 14.47 ± 7.28 min, respectively]. No significant differences were detected in heart and respiratory rates and arterial oxygen saturation between treatments. Blood glucose concentration (18.3 ± 3.6 versus 11.8 ± 1.2 mmol/L) and spontaneous urinary voiding [35.9 (15.1–41.6), range (median) versus 0.9 (0–8.0) mL /kg/min] were significantly higher without vatinoxan. Conclusions: Acceleration of induction of sedation, alleviation of hyperglycaemia and prevention of profuse diuresis by vatinoxan may be beneficial when sedating rats for clinical and experimental purposes with subcutaneous medetomidine, midazolam and fentanyl. [ABSTRACT FROM AUTHOR]

The optimal diuretic doses of quercetin and rutin (5 mg/kg) and dihydroquercetin and hyperoside (1 mg/kg) were determined in experiments on white rats with a single intragastric administration. The mechanism of action of sodium quercetin and its derivatives on glomerular filtration and tubular transport was studied in acute experiments. Quercetin, dihydroquercetin, rutin, and hyperoside with a single intramuscular injection at the above doses contributed to an increase in diuresis, saluresis, creatinine clearance (except for rutin), and excreted sodium fraction by an average of 141%, 203%, 153%, and 189%, respectively (p < 0.05). Rutin also led to a decrease in the creatinine concentration index (by an average of 79%, p < 0.05). The diuretic furosemide with a single intramuscular injection at the threshold dose of 1 mg/kg increased diuresis, saluresis, and excreted sodium fraction (by an average of 187%, p < 0.05), like the effect of the quercetin derivatives; decreased the creatinine concentration index (by an average of 62%, p < 0.05); and did not affect creatinine clearance identically to the effect of rutin. [ABSTRACT FROM AUTHOR]

This article highlights a selection of important nephrology studies published in 2023 that have relevance for nonnephrologist physicians. Four studies examined progression of chronic kidney disease or cardiovascular disease with respect to finerenone use, magnesium supplementation, iron markers, and COVID-19. Two studies examined treatments to improve specific aspects of chronic kidney disease management, including daprodustat to address anemia and patiromer to address hyperphosphatemia. One study showed that acetazolamide added to loop diuretics increased diuresis in acute decompensated heart failure across a wide range of renal function. Another study found that once-daily hydrochlorothiazide did not prevent kidney stone recurrence. Finally, an antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infection in frail older adults. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter 2 inhibitors are believed to improve cardiac outcomes due to their osmotic diuretic potential. The goal of this study was to test the hypothesis that vasopressin-driven urine concentration overrides the osmotic diuretic effect of glucosuria induced by dapagliflozin treatment. DAPA-Shuttle1 (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment) was a single-center, double-blind, randomized, placebo-controlled trial, in which patients with chronic heart failure NYHA functional classes I/II and reduced ejection fraction were randomly assigned to receive dapagliflozin 10 mg daily or placebo (1:1) for 4 weeks. The primary endpoint was change from baseline in urine osmolyte concentration. Secondary endpoints included changes in copeptin levels and solute free water clearance. Thirty-three randomized, sodium-glucose cotransporter 2 inhibitor–naïve participants completed the study, 29 of whom (placebo: n = 14; dapagliflozin: n = 15) provided accurate 24-hour urine collections (mean age 59 ± 14 years; left ventricular ejection fraction 31% ± 9%). Dapagliflozin treatment led to an isolated increase in urine glucose excretion by 3.3 mmol/kg/d (95% CI: 2.51–4.04; P < 0.0001) within 48 hours (early) which persisted after 4 weeks (late; 2.7 mmol/kg/d [95% CI: 1.98–3.51]; P < 0.0001). Dapagliflozin treatment increased serum copeptin early (5.5 pmol/L [95% CI: 0.45-10.5]; P < 0.05) and late (7.8 pmol/L [95% CI: 2.77–12.81]; P < 0.01), leading to proportional reductions in free water clearance (early: −9.1 mL/kg/d [95% CI: −14 to −4.12; P < 0.001]; late: −11.0 mL/kg/d [95% CI: −15.94 to −6.07; P < 0.0001]) and elevated urine concentrations (late: 134 mmol/L [95% CI: 39.28–229.12]; P < 0.01). Therefore, urine volume did not significantly increase with dapagliflozin (mean difference early: 2.8 mL/kg/d [95% CI: −1.97 to 7.48; P = 0.25]; mean difference late: 0.9 mL/kg/d [95% CI: −3.83 to 5.62]; P = 0.70). Physiological-adaptive water conservation eliminated the expected osmotic diuretic potential of dapagliflozin and thereby prevented a glucose-driven increase in urine volume of approximately 10 mL/kg/d · 75 kg = 750 mL/kg/d. (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment [DAPA-Shuttle1]; NCT04080518). [Display omitted] [ABSTRACT FROM AUTHOR]

The primary goals during acute heart failure (AHF) hospitalization are decongestion and guideline-directed medical therapy (GDMT) optimization. Unlike diuretics or other GDMT, early dapagliflozin initiation could achieve both AHF goals. The authors aimed to assess the diuretic efficacy and safety of early dapagliflozin initiation in AHF. In a multicenter, open-label study, 240 patients were randomized within 24 hours of hospital presentation for hypervolemic AHF to dapagliflozin 10 mg once daily or structured usual care with protocolized diuretic titration until day 5 or hospital discharge. The primary outcome, diuretic efficiency expressed as cumulative weight change per cumulative loop diuretic dose, was compared across treatment assignment using a proportional odds model adjusted for baseline weight. Secondary and safety outcomes were adjudicated by a blinded committee. For diuretic efficiency, there was no difference between dapagliflozin and usual care (OR: 0.65; 95% CI: 0.41-1.02; P = 0.06). Dapagliflozin was associated with reduced loop diuretic doses (560 mg [Q1-Q3: 260-1,150 mg] vs 800 mg [Q1-Q3: 380-1,715 mg]; P = 0.006) and fewer intravenous diuretic up-titrations (P ≤ 0.05) to achieve equivalent weight loss as usual care. Early dapagliflozin initiation did not increase diabetic, renal, or cardiovascular safety events. Dapagliflozin was associated with improved median 24-hour natriuresis (P = 0.03) and urine output (P = 0.005), expediting hospital discharge over the study period. Early dapagliflozin during AHF hospitalization is safe and fulfills a component of GDMT optimization. Dapagliflozin was not associated with a statistically significant reduction in weight-based diuretic efficiency but was associated with evidence for enhanced diuresis among patients with AHF. (Efficacy and Safety of Dapagliflozin in Acute Heart Failure [DICTATE-AHF]; NCT04298229) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This study evaluates the association of diuresis and hydration through a new monitoring indicator called U sen and the risk of acute kidney injury in patients treated with cisplatin based-EXTREME regimen. Methods: We retrospectively reviewed all the cycles of patients with recurrent and/or metastatic head and neck cancer who received cisplatin based-EXTREME regimen from June 2008 to July 2022. Hydration regimen, urine output and concomitant treatments data were collected on the day of cisplatin infusion and the following day of each course received. Results: Of the 110 courses received by 46 patients, 38 (34.5%) results in AKI. No patient characteristics showed a significant difference between AKI (70%) and non-AKI (30%) group. In univariate analysis, dose reduction of cisplatin (odds ratio = 0.166 [0.04; 0.75], p = 0.01)) and U sen >8 (odds ratio = 0.316 [0.133; 0.755], p = 0.015) and cardiac treatments (odds ratio = 3.24 [1.26; 8.52], p = 0.02) were significantly associated with AKI risk. In multivariate analysis, cisplatin dose reduction (odds ratio = 0.129 [0.0241; 0.687], p = 0.016) and U sen >8 (odds ratio = 0.184 [0.0648; 0.523], p = 0.0015) were associated with a risk reduction of cisplatin-related AKI. Concomitant administration of cardiac treatments (odds ratio = 3.18 [1.1; 9.22], p = 0.033) showed an increased risk of cisplatin-related AKI. Conclusion: The combination of diuresis and i.v. hydration through the U sen composite score was shown to be associated with cisplatin-induced AKI risk in patients treated with cisplatin based EXTREME regimen. It could be used as a practical indicator to trigger specific clinical management to limit the risk of cisplatin induced AKI. [ABSTRACT FROM AUTHOR]

Although body fluid volume control by the kidneys may be classified as a long-term arterial pressure (AP) control system, it does not necessarily follow that the urine flow (UF) response to changes in AP is slow. We quantified the dynamic characteristics of the UF response to short-term AP changes by changing mean AP between 60 mmHg and 100 mmHg every 10 s according to a binary white noise sequence in anesthetized rats (n = 8 animals). In a baro-on trial (the carotid sinus baroreflex was enabled), the UF response represented the combined synergistic effects of pressure diuresis (PD) and neurally mediated antidiuresis (NMA). In a baro-fix trial (the carotid sinus pressure was fixed at 100 mmHg), the UF response mainly reflected the effect of PD. The UF step response was quantified using the sum of two exponential decay functions. The fast and slow components had time constants of 6.5 ± 3.6 s and 102 ± 85 s (means ± SD), respectively, in the baro-on trial. Although the gain of the fast component did not differ between the two trials (0.49 ± 0.21 vs. 0.66 ± 0.22 lL·min-1·kg-1·mmHg-1), the gain of the slow component was greater in the baro-on than in the baro-fix trial (0.51 ± 0.14 vs. 0.09 ± 0.39 lL·min-1·kg-1·mmHg-1, P = 0.023). The magnitude of NMA relative to PD was calculated to be 32.2 ± 29.8%. In conclusion, NMA contributed to the slow component, and its magnitude was approximately one-third of that of the effect of PD. [ABSTRACT FROM AUTHOR]

Aim: We examined the acute effects of a moderate alcohol dose (48 g) ingested before prolonged cycling on acute physiological responses in eight healthy males (mean ± SD; 23 ± 2 years; 1.77 ± 0.04 m; 75.8 ± 4.1 kg). Methods: In a randomized order, euhydrated participants completed two experimental sessions with the sequence of 150-min seated at rest, 90-min of cycling at 50% of the maximal rate of oxygen consumption (⁠|$\dot{\textrm V}\textrm O$| 2max), 120-min seated at rest. Participants drank 250 mL of flavored squash with or without alcohol (vodka; ~16 g) at 10, 40, and 70 min of the initial resting phase, giving a cumulative fluid intake of 750 mL with 48 g of alcohol. Heart rate, blood glucose, breath alcohol concentration, and respiratory gasses were recorded throughout the entire trial with cumulative urine volume recorded during both rest phases. Results: Total carbohydrate (control = 115 ± 19 g: alcohol = 119 ± 21 g; P  = 0.303) and lipid (control = 17 ± 4 g: alcohol = 20 ± 7 g; P  = 0.169) oxidation was similar between conditions. Average heart rate was 7% higher in the alcohol condition (control = 111 ± 12 bpm; alcohol = 119 ± 11 bpm; P  = 0.003). Blood glucose concentrations were similar between conditions during (P  = 0.782) and after exercise (P  = 0.247). Urine output was initially increased between conditions following alcohol ingestion before diminishing (P  < 0.001) with no difference in total cumulative urine output (P  = 0.331). Conclusion: Consuming an alcoholic drink containing 48 g of alcohol in the hour before moderate intensity sub-maximal aerobic exercise led to detectable increases in heart rate and rate of urine production with no effect on substrate use. [ABSTRACT FROM AUTHOR]

Constipation is one of the most common symptoms in childhood. Sodium-phosphate enemas are frequently preferred for the treatment of constipation and bowel cleansing. We present a case of a 5-year-old boy who presented to the Pediatric Emergency Department with complaints of constipation, abdominal pain, abdominal distension and vomiting; had been constipated for about two years and had poor nutrition, and received a full dose of CT enema® twice in the last 12 hours before admission to the hospital. Upon arrival at the Pediatric Emergency Department, the patient was given a pediatric fleet enema because he had dense stools according to radiographic evidence. Poisoning due to Sodium-phosphate enema was considered due to severe hyperphosphatemia and hypocalcemia in the laboratory evaluation. Rapid intravenous hydration and 1 mL/kg calcium gluconate intravenous infusion were started. Electrolytes returned to the normal range at the 14th hour of follow-up without the need for additional treatment. This case is presented to emphasize that due to the widespread use of sodium-phosphate enemas in the treatment of chronic constipation, these enemas can cause phosphate poisoning even when used in healthy patients at therapeutic doses. [ABSTRACT FROM AUTHOR]