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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
In select patients hospitalized for ADHF with evidence of volume overload, refractory hyponatremia, or presence of risk factors for hyponatremia-related cognitive symptoms, the short-term use of vasopressin antagonists may be considered.6,9 Conivaptan is a non-selective IV vasopressin antagonist of both V1A and V2 receptors with greater affinity for the V2 receptors (10:1).46,47 Tolvaptan is a selective V2 receptor antagonist. Through inhibition of V2 receptors, both drugs prevent water reabsorption via aquaporin 2 channels in the collecting ducts of the kidney, resulting in aquaresis.46,47 Blockade of peripheral V1A receptors by conivaptan counteracts vasopressin-induced vasoconstriction, improves hemodynamic indices, and may prevent myocardial hypertrophy.46–48
Hyponatremia in pregnancy
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Anthony Parravani, Bethany Pellegrino
Nonpregnant state, maintenance of serum osmolality and sodium:Under nonpregnant conditions, serum osmolality is maintained within a narrow range of 275–295 mOsm/L.Any changes in serum osmolality are sensed by osmoreceptors which respond to correct the change.An increase in serum osmolality by 1–2% results in the release of ADH from the posterior pituitary, which acts on the Arginine Vasopressin Receptor 2 (AVPR2) on the basolateral membrane of the collecting ducts in the kidneys. This leads to the upregulation of aquaporin 2 channels and increased water absorption by the kidneys.Any increase in serum osmolality also stimulates the thirst center in the hypothalamus, resulting in water intake to assist in correction of the hypertonic state.4
Rhubarb
Published in Mahendra Rai, Shandesh Bhattarai, Chistiane M. Feitosa, Ethnopharmacology of Wild Plants, 2021
Gan B. Bajracharya, Richa K. Gupta
Rhubarb is well known for its cathartic and diuretic effects, which are closely correlated with water adjustment of colon and kidney by the theory of traditional Chinese medicine (Li et al. 2008). Researches have indicated that the anthraquinone glycosides can bring about fairly obvious effects of ‘watery diarrhea’. Rhubarb regulates aquaporins in the colon that lead to less absorption of water and more secretion of intestinal juice. It is likely that aquaporin 2 is regulated through protein kinase A signal pathway (Zhang et al. 2008).
Localization and characterization of proenkephalin-A as a potential biomarker for kidney disease in murine and human kidneys
Published in Biomarkers, 2023
Michaela Alexandra Anna Fuchs, Julia Schrankl, Charlotte Wagner, Christoph Daniel, Armin Kurtz, Katharina Anna-Elisabeth Broeker
Penk was expressed by interstitial fibroblast like cells and myofibroblasts after renal damage (Figure 5). In contrast, Lcn2 and KIM-1 mRNA were detected exclusively in tubular structures of damaged kidneys after UUO and adenine-induced nephropathy (Figure 6). Lcn2 was detected in distal tubules and aquaporin 2 (AQP2) (Figure 6B) expressing collecting ducts in the outer and inner medulla. Damaged tubules with strong Lcn2 expression were surrounded by Penk+ interstitial cells. There was, however, no co-localization of these two makers in the same cells (Figure 6A). KIM-1 expression on the other hand was restricted to proximal tubules co-expressing megalin in the renal cortex (Figure 6C). No expression of Penk mRNA could be detected in or around KIM-1+ tubules. Expression of tubule specific markers like megalin or AQP2 was weaker in damaged tubules with increased expression of Lcn2 and KIM-1. Exemplary details of the co-localization studies are shown in tissues of mice after 3weeks AN. mRNA expression patterns and cell-types expressing Penk were the same in UUO damaged kidneys.
Physiological characterization of an arginine vasopressin rat model of preeclampsia
Published in Systems Biology in Reproductive Medicine, 2022
Sapna Ramdin, Thajasvarie Naicker, Virushka Pillay, Sanil D. Singh, Sooraj Baijnath, Blessing N Mkhwanazi, Nalini Govender
Glomerular damage increases glomerular permeability, thereby permitting entry of larger-sized proteins into the filtrate. The increase in peripheral vascular resistance due to AVP treatment, elevates systemic BP with consequent glomerular injury (Santillan et al. 2014) as demonstrated by the higher urinary protein levels observed in the AVP-treated rats in our study. Kidney histology as shown in Figure 4 highlights the effects of mild increase in mesangium, mild glomerular crescents and reduction in the Bowman’s space in AVP-treated rats (NAVP and PAVP). The Bowman’s capsular space protects glomerular function by acting as a shield against leukocyte infiltration (Chen et al. 2018). Glomerular epithelial crescents produced by the aggregation of inflammatory cells and proliferating epithelial cells in the Bowman’s space, are characteristic of glomerulonephritis (D’Souza et al. 2013). Thus, our data suggest an AVP-induced leukocyte infiltration and accompanying glomerular damage may contribute to increased urinary protein levels in the AVP- treated groups. In our study, water intake increased proportionally with gestational days amongst the pregnant (PAVP and PS) and NAVP groups, while urinary output reduced significantly in PAVP rats compared to the PS rats. Reductions in urinary output may be attributed to the antidiuretic effect of AVP, via V2 receptor activation and increased expression of aquaporin-2 channels resulting in water retention and reduced urinary output (Guelinckx et al. 2016).
Development of hyponatremia after terlipressin in cirrhotic patients with acute gastrointestinal bleeding: a retrospective multicenter observational study
Published in Expert Opinion on Drug Safety, 2020
Xiangbo Xu, Su Lin, Yida Yang, Yu Chen, Bang Liu, Bimin Li, Yunhai Wu, Fanping Meng, Qiang Zhu, Yiling Li, Shanhong Tang, Shanshan Yuan, Lichun Shao, Xingshun Qi
Terlipressin primarily acts on the V1 receptors which are located in the vascular smooth muscle of the splanchnic circulation to cause splanchnic vasoconstriction and then reduce portal pressure and increase renal blood flow [1]. It has been recommended as the first-line choice of vasoactive drug for acute variceal bleeding [2–6] or hepatorenal syndrome [7,8] in cirrhotic patients. Additionally, terlipressin can stimulate the V2 receptors to increase the number of aquaporin-2 and then enhance the ability of renal collecting ducts in water reabsorption, thereby leading to the development of dilutional hyponatremia [9–12]. The incidence and risk factors of hyponatremia in patients who were treated with terlipressin had been analyzed in previous studies [13–15]. However, all of them had a relatively small sample size and defined hyponatremia as a dynamic decrease in serum sodium concentration of ≥5 mmol/L rather than according to the current practice guidelines [3].