SummaryBackground and objectives The significance of renal parenchymal volume and the factors that influence it are poorly understood.Design, setting, participants, & measurements Renal parenchymal volume (RPV) was measured on contrastenhanced CT scans after exclusion of sinus fat and vessels in 224 healthy subjects evaluated as kidney donors and in a separate cohort of 22 severely obese individuals before and after 6 months of weight loss. GFR was measured by iohexol clearance in 76 of the transplant donors. RPV was correlated with age, GFR, and various anthropometric parameters. ResultsIn potential transplant donors, RPV correlated with body surface area (BSA; r ϭ 0.68) and was 7% larger in men but did not vary with age or race. Gender and body size were independent determinants of RPV. RPV correlated well with GFR (r ϭ 0.62) and accounted for almost all of the variability in a model of GFR that included age, race, gender, and body surface area. GFR correlated more strongly with RPV than with creatinine-based equations. The same relationship between RPV and BSA was observed in obesity, and RPV decreased with weight loss. ConclusionsIn healthy adults younger than 65 years, renal parenchymal volume is governed by body size and gender but not age or race and is strongly correlated with GFR. This indicates that renal parenchymal volume varies to meet metabolic demand and is closely linked to renal function.

Abstract. Increased cGMP-specific phosphodiesterase (PDE5) activity in renal inner medullary collecting duct (IMCD) cells contributes to resistance to atrial natriuretic peptide (ANP) and the excessive sodium retention seen in experimental nephrotic syndrome and liver cirrhosis. Normal pregnancy is also accompanied by sodium retention and plasma volume expansion, and pregnant rats are resistant to the natriuretic action of ANP. The authors investigated a possible role of increased renal PDE5 activity in the physiologic sodium retention of normal rat pregnancy. The natriuresis and increased urinary cGMP excretion (U cGMP V) evoked by acute volume expansion (a measure of renal responsiveness to endogeneous ANP) was blunted in 16-d pregnant versus virgin rats, despite equivalent increases in circulating ANP in pregnants and virgins. The ANP-dependent cGMP accumulation in isolated IMCD cells from pregnants was blunted versus virgins and restored by the PDE5-selective antagonist DMPPO (10 Ϫ7 mol/L). PDE5 activity in vitro and PDE5 protein abundance in IMCD were greater in pregnants. Four days postpartum, volume expansion natriuresis, U cGMP V, and PDE5 protein levels in IMCD cell homogenates had returned to virgin values. These results demonstrate that normal rat pregnancy leads to in vivo and in vitro renal resistance to ANP, in association with heightened activity of the cGMP-specific PDE5 in IMCD. This may contribute to the physiologic sodium retention of normal pregnancy.Normal pregnancy is characterized by marked maternal hemodynamic changes, including a profound plasma volume expansion. In women, a maximum increment of approximately 50% occurs; in the pregnant rat, an increase of 80 to 100% is normal (1-4). This large plasma volume expansion represents an "optimal, physiologic" response; in women, failure to volume expand is associated with poor reproductive performance and is also a feature of preeclampsia (1-3). The plasma volume expansion results from a slow, cumulative net renal sodium retention, the mechanism of which is unclear because there are many conflicting signals to the kidney in pregnancy. For example, large increases occur in circulating angiotensin and aldosterone levels, ureteral pressure increases and systemic BP falls, all of which will promote net sodium retention. On the other hand, several natriuretic systems are also activated, including the large (30 to 50%) increase in GFR, high progesterone levels that exert a marked antimineralocorticoid action, increased plasma atrial natriuretic peptide (ANP) concentration, increased renal production of nitric oxide (NO), and decreased renal Na,K-ATPase abundance and activity, (3-7).In the case of ANP, there is evidence of a selective renal resistance to the natriuretic actions of ANP in normal rat pregnancy (8), which could contribute to a "permissive" renal sodium retention and plasma volume expansion. Renal resistance to ANP-mediated natriuresis coupled with cumulative sodium retention and volume expansion are also seen in several pathologic cond...

Background and Objectives: Depression has acknowledged and well documented, is common among orthopaedic inpatients may be associated with functional outcomes. Authors aimed to investigate the role, prevalence and associating factors of depression disorder in orthopaedic inpatients. Materials and Methods: A cross-sectional study is designed among patients that admitted at Sri Aurobindo Medical College and P. G. Institute, Indore. Four hundred twenty six orthopedic patients were recruited for study. The demographic and clinical measurements were recorded. Levels of depression were assessed by using Zung's depression scale. Results: Depressive disorder was identified in 87.6% indoor patients significantly (p<0.001) influenced female more than male. The mean depression score in female (67.37±11.75) was significantly higher than male (62.29±12.20). The prevalence of extreme/major depression in female (46.6%) was higher as compared to male (25.7%). Type of trauma was found significantly (p<0.05) associated with depressive disorder. 38.1% male with traumatic condition and 20.0% with non-traumatic condition had moderate depression in comparison to 31.4% and 13.6% female. Depressive disorder was found significantly associated with sex (p<0.001), socio-economic status (p<0.001), length of ortho-illness (p<0.001), length of stay in hospital (p<0.001), exercise/yoga (p<0.05) and type of injury (p<0.05). Conclusions: Higher incidence of depressive disorder recorded in female. Prevention and treatment require more clinical and research attention to reduce the public health burden of depression. The study suggested that higher depressive disorder does occur in indoor orthopaedic patients that associated with various functional outcomes. This study supports the view of depressive disorder was disabling factor in better functional recovery and frequent in female after orthopedic trauma.

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Family history of end-stage renal disease (ESRD) is a strong risk factor for chronic kidney disease (CKD), but the underlying mechanism is unknown. Kidney mass may also be a risk factor. Increased kidney size is associated with albuminuria in diabetes and with poorer prognosis in polycystic kidney disease. We investigated whether renal parenchymal volume (RPV) in adults is a risk factor for CKD by comparing RPV in potential living related and unrelated kidney donors. RPV was measured by tracing the kidneys, excluding sinus fat, calyces, and vessels on sequential transverse images from CT scans of 106 related and 51 unrelated potential kidney donors. Unrelated donors were more likely to be female and Caucasian, but there was no difference in age, body surface area (BSA), and body mass index (BMI). In a multivariate analysis that accounted for age, gender, BSA, and race, relatedness correlated strongly with RPV (p = .0034). After correction for BSA and gender, RPV was 6.3% larger in related donors. The increase was 7.3% in first-degree relatives and 2.7% in second-degree relatives. The increase was apparent when the end-stage diagnosis in the recipient was glomerulonephritis (7.3%), hypertension (6.6%), and other/unknown (7.8%) but not diabetes (1%). Glomerular filtration rate (GFR) was measured as the plasma clearance of iohexol given as a contrast agent for CT scan. Five blood plasma samples were obtained at 30-minute intervals starting 2 hours after the CT scan in 39 subjects. The dose of iohexol was determined by weighing the bottle and syringe before and after injection and iohexol concentration was measured by high-performance liquid chromatography (HPLC). GFR was derived from a single-pool model with a Brochner-Mortensen correction. The increase in RPV was not associated with a higher GFR, suggesting that there is a decrease in renal functional density. Therefore, we conclude that a family history of ESRD is associated with an increase in renal parenchymal volume that correlates with the degree of genetic similarity and may be disease specific; nevertheless more studies are needed to confirm these preliminary data.