Effects of restorative proctocolectomy on renal and adrenal function

Huber, F.-X.; Stern, J.; Hinz, Ulf; Werle, E; Haack, D.; Kienle, Peter; Heuschen, U.; Aulmann, M.; Decker-Baumann, C; Herfarth, Ch.

doi:10.1007/bf02234222

Cited by 25 publications

(12 citation statements)

References 21 publications

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“…These results suggest that the patients after the second operation for UC were dehydrated even after 20-30 weeks had passed since the first operation in which the ileostomy was constructed. This result coincided with that in a previous study by Huber et al that reported increased plasma levels of aldosterone in patients after total colectomy 8) . Delin et al reported the shorter length of small bowel after proctocolectomy with various ileal resections, the more the increase in plasma levels of renin and aldosterone after the operation, and they concluded that measurement of renin and aldosterone levels should be used for evaluation of the severity of sodium deficiency 9) .…”

Section: Discussionsupporting

confidence: 93%

“…The patients were assigned randomly into two groups using a table of random numbers. The patients in group A initially ingested ORS (Na + 50 mEq/L, K + 20 mEq/L, Cl 50 mEq/L, Mg 2+ 2 mEq/L, P 2 mmol/L, Lactate 31 mEq/L, Glucose 1.8%) (1000 mL/day) for the first 7 days (days 1-7) and mineral water (Na + 0.49 mEq/L, K + 0.046 mEq/L, Mg2+ 0.44 mEq/L, Glucose 0%) (1000 mL/day) was given for the next 7 days (days [8][9][10][11][12][13][14]. Conversely, patients in group B initially drank mineral water (1000 mL/day) for the first 7 days and ORS (1000 mL/day) was given for the next 7 days.…”

Section: Methodsmentioning

confidence: 99%

“…Renin finally increases the secretion of aldosterone and the antidiuretic hormone vasopressin via the angiotensin pathway. Hyperaldosteronism was observed after total colectomy in rats and after IPPA in humans 7,8) . Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency 9) .…”

Section: Introductionmentioning

confidence: 99%

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Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

Kudoh

Shibata²,

Funayama

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: The possible effects and benefits of oral rehydration solution (ORS) on chronic dehydration after total proctocolectomy. Methods: To evaluate the effect of ORS on the renin-angiotensin system after remnant proctocolectomy in patients with ulcerative colitis (UC), we selected 20 patients after remnant proctocolectomy, ileal J pouch-anal anastomosis, and construction of a diverting ileostomy for UC. Patients were randomly divided into two groups, A (n=9) or B (n=11), 2 weeks after the surgery. In group A, ORS (1000 mL/day) was given for the first 7 days and mineral water (1000 mL/day) for the next 7 days. In group B, mineral water (1000 mL/day) was given for the first 7 days and ORS (1000 mL/day) for next 7 days. Plasma levels of renin, aldosterone and excretion of sodium in urine were evaluated at days 0, 7, and 14. We defined day 0 as the day of beginning this study. Results: Mean plasma renin levels on day 0 were six to eight times greater than the upper normal limit. In group A, ORS lowered plasma renin levels. In group B, plasma levels of renin and aldosterone after ORS were lower than those at days 0 and 7. Conclusions: ORS corrected increased plasma levels of renin and aldosterone to within the normal range in patients after proctocolectomy.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

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Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

Kudoh

Shibata²,

Funayama

et al. 2017

J Anus Rectum Colon

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“…Patients with an ileostomy are particularly vulnerable to these problems because of the metabolic acidosis of bicarbonate wasting, but also because of the reduced total body fluids, resulting in stimulation of the renin-angiotensin mechanism, intrarenal vasoconstriction, and secondary hyperaldosteronism [14,15]. The sodium bicarbonate therapy in our patient was probably of additional benefit by correcting these abnormalities as well as the acidosis.…”

Section: Discussionmentioning

confidence: 84%

Urate Nephropathy following Chronic Ileostomy Acidosis

Randall

2002

Am J Nephrol

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Normal renal function and normal urinalysis results in an 81-year-old man deteriorated over a 6-month period following an ileostomy, associated with metabolic acidosis, persistent aciduria, proteinuria, and a urinary sediment that showed numerous red blood cells, granular casts, and ‘reactive’ epithelial cells with intracellular uric acid (UA) crystals. These also formed extensive UA casts. Oral sodium bicarbonate therapy completely reversed all of the abnormalities. Renal biopsy, while it failed to demonstrate significant tubular obstruction, showed evidence of extensive epithelial cell injury. It is suggested that intestinal losses of bicarbonate resulted in persistent excretion of an acidic urine which promoted UA crystal formation within renal tubules and in epithelial cells which then caused cellular injury and the release of cytokines, leading to an altered regulation of the renal blood flow. The importance of microscopic techniques in the diagnosis is stressed along with the significance for managing both acute and chronic renal failure.

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“…In humans, Huber et al thoroughly investigated the renal and adrenal function in the process of an elective two-step proctocolectomy with ileal pouch-anal anastomosis by measuring the electrolyte and hormone metabolite levels in both the urine and blood. 25 They also concluded that functional secondary hyperaldosteronism plays a central role in subsequent renal adaptation. The present data support the idea that renal adaptation following a total proctocolectomy depends, at least in part, on the molecular induction principally regulated by circulating aldosterone.…”

mentioning

confidence: 98%

Renal Expression of the Essential Genes Associated with Sodium Transport Following a Total Proctocolectomy in Rats

et al. 2005

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The water and electrolyte balance is regulated by the renin-angiotensin-aldosterone system in the kidney. We previously reported that the levels of circulating aldosterone dramatically increased following a total proctocolectomy in rats. However, there is no direct evidence regarding whether renal adaptation is accelerated by the induction of aldosterone-associated molecules. To explore this question, Sprague-Dawley rats underwent total proctocolectomies and then were killed 8 weeks later. We investigated the renal expression of 11beta-hydroxysteroid dehydrogenase type 2, the alpha-, beta-, and gamma-subunits of the epithelial sodium channel, and the alpha1- and beta1-subunits of Na+,K+-ATPase mRNAs because those molecules are responsible for the aldosterone specificity for mineralocorticoid receptor, amiloride-sensitive sodium absorption, and sodium extrusion from distal tubules, respectively. A Northern blot analysis demonstrated the kidney to exhibit mRNA induction for all of these molecules, thus supporting the idea that renal adaptation following a total proctocolectomy depends, at least in part, upon the molecular induction which is principally regulated by circulating aldosterone.

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Effects of restorative proctocolectomy on renal and adrenal function

Cited by 25 publications

References 21 publications

Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

Urate Nephropathy following Chronic Ileostomy Acidosis

Renal Expression of the Essential Genes Associated with Sodium Transport Following a Total Proctocolectomy in Rats

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