Hyperkalemic Distal Renal Tubular Acidosis Associated with Obstructive Uropathy

Batlle, Daniel; Arruda, José A.L.; Kurtzman, Neil A.

doi:10.1056/nejm198102123040701

Cited by 252 publications

(93 citation statements)

References 19 publications

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“…Both erythropoietin and 1,25-hydroxy vitamin D are produced in the tubulointerstitium, and progression of kidney disease, regardless of etiology, results in gradual tubulointerstitial fibrosis and atrophy (6)(7)(8). Similarly, the mechanism of metabolic acidosis is primarily associated with tubulointerstitial injury and is independent of GFR to some extent (9)(10)(11)(12)(13). This clustering of medication use suggests that patients manifesting evidence of tubulointerstitial injury, regardless of CKD stage, may benefit from more active and targeted screening for related comorbidities, in addition to the usual screening that is dictated by progression of CKD stage.…”

Section: Discussionmentioning

confidence: 99%

Medication Treatment Complexity and Adherence in Children with CKD

Blydt-Hansen

Pierce

Cai

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed.Design, setting, participants, & measurements In this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days.Results The 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m 2 ; 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P,0.001) and glomerular disease (1.4-fold versus nonglomerular; P,0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration .2 times/d; P,0.001) but not the number of medications.Conclusions Medical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.

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Section: Discussionmentioning

confidence: 99%

Medication Treatment Complexity and Adherence in Children with CKD

Blydt-Hansen

Pierce

Cai

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Key words: electrophysiology potassium conductance * sodium conductancesodium pump * unilateral ureteral obstruction Unilateral ureteral obstruction (UUO)' causes a number of alterations in renal function ofboth obstructed and untouched contralateral kidneys ( 1,2). Abnormalities in Na+ and water conservation and in H+ and K+ excretion (3)(4)(5)(6)(7)(8)(9) are known to occur in the distal nephron segments, including the cortical collecting duct (CCD), from the obstructed kidney after UUO. However, the mechanisms underlying these disorders have not been fully evaluated.…”

Section: Introductionmentioning

confidence: 99%

Electrical properties of the rabbit cortical collecting duct from obstructed and contralateral kidneys after unilateral ureteral obstruction.

Muto

Miyata²,

Asano³

1993

J. Clin. Invest.

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IntroductionElectrophysiological techniques were used to determine the electrical properties of the collecting duct (CD) cell in the isolated cortical collecting duct from obstructed (UUOOK) and contralateral (UUOcK) kidneys in rabbits 24 h after unilateral ureteral obstruction (UUO); results were compared with those from sham-operated kidneys. The lumen-negative transepitheHal voltage and the basolateral membrane voltage (V B) were decreased in the UUOOK, and increased in the UUOCK. The transepithelial conductance (GT) was decreased in parallel with an increase in the fractional apical membrane resistance (fRA) and a decrease in apical membrane conductance in the UUOOK. By contrast, the GT was increased in parallel with increases in apical and basolateral membrane conductances in the UUOCK. The amiloride-sensitive changes in apical membrane voltage (V A), GT and f RA were lower in the UUOOK, but greater in the UUOCK. The changes in V A and GT upon raising the perfusate K+ concentration and upon addition of luminal Ba2" were decreased in the UUOOK, and increased in the UUOCK. Addition of ouabain to the bath resulted in a smaller depolarization ofV B in the UUOOK, but in a greater depolarization in the UUOCK. Upon lowering bath Cl-, the change in basolateral membrane electromotive force (AEMF) was increased in the UUOOK, and decreased in the UUOCK. Reversely, upon raising bath K+, the AEMF was decreased in the UUOOK, and increased in the UUOCK. We conclude: (a) the conductances of Na+ and K+ in the apical membrane, and active Na+-K+ pump activity and relative K+ conductance in the basolateral membrane are decreased in the UUOOK, and increased in the UUOCK; (b) the relative basolateral membrane CI-conductance was increased in the UUOOK, and decreased in the UUOCK. Unilateral ureteral obstruction (UUO)' causes a number of alterations in renal function ofboth obstructed and untouched contralateral kidneys ( 1, 2). Abnormalities in Na+ and water conservation and in H+ and K+ excretion (3-9) are known to occur in the distal nephron segments, including the cortical collecting duct (CCD), from the obstructed kidney after UUO. However, the mechanisms underlying these disorders have not been fully evaluated. Only a few studies have assessed some of them at a segmental level. The in vitro microperfusion studies of the rabbit CCD have demonstrated that ureteral obstruction led to decreases in the lumen-negative transepithelial voltage (6, 8) as well as in Na+ reabsorption (6). These changes also included decreases in Na+-K+-ATPase activity (9) and in Na+-K+ pump in situ turnover (4) in the CCD from the obstructed rat kidney after UUO. These observations have suggested that the collecting duct (CD) cell would be functionally impaired after ureteral obstruction, because the CD cell is mainly responsible for Na+ and K+ transports in the CCD (10-15). However, the cellular mechanisms of the defects in Na+ and K+ transports in the CCD from obstructed kidneys remain unknown.In addition, there is little information regardi...

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“…5). On the other hand, the relative conductances of Cl-and K+ were, respectively, decreased and increased in the CCD from UUO animals (14) ( ) (9) (8) (+ CONTROL (16) (-) (9) *tt .…”

Section: Discussionmentioning

confidence: 95%

“…Pretreatment of renal decapsulation also partially corrected the changes in tc, and tK seen in UUO animals, whereas it had no effect in control animals. We conclude that, in UUO animals, renal decapsulation partially corrects the inhibition of apical Na+ and K+ conductances as well as basolateral Na+-K+ pump activity and relative K+ conductance seen after UUO, whereas in control animals it has no Introduction Urinary tract obstruction is associated with a number of defects in renal function in the rat (1)(2)(3)(4), dog (5,6), and humans (7,8). Studies in animals with experimentally induced obstructive uropathy have shown transport defects mainly in the distal nephron segments, including the cortical collecting duct (CCD),' characterized by impaired Na' and water reabsorption and decreased secretion of H' and K+ (1, 3,4,8,9).…”

mentioning

confidence: 91%

Electrical properties of the rabbit cortical collecting duct from obstructed kidneys after unilateral ureteral obstruction. Effects of renal decapsulation.

Muto¹,

Asano²

1994

J. Clin. Invest.

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Ureteral obstruction causes impaired salt wastage and K+ secretion in the distal nephron segments, including the cortical collecting duct (CCD). Recently, we demonstrated that conductances of Na+ and K+ in the apical membrane, as well as the electrogenic Na+-K+ pump activity and the relative K+ conductance in the basolateral membrane of the collecting duct cell, were inhibited in the obstructed kidney after unilateral ureteral obstruction (UUO). To examine whether the increased intrarenal pressure might be causally related to these abnormalities in the CCD, the effects of unilateral renal decapsulation, a maneuver that partially blocks the increase in renal pressure, were evaluated with microelectrode techniques in isolated CCDs from UUO and sham-operated (control) rabbits 24 h after operation. Renal decapsulation had no effects on barrier voltages and conductances in the CCD from control animals. The lumen-negative transepithelial (VT) and basolateral membrane (VB) voltages as well as the transepithelial (GT) and the apical membrane (GA) conductances were decreased in the CCD from UUO animals compared with control animals. Pretreatment of renal decapsulation partially corrected the decreases in VT, VB, GT, and GA seen in the CCD from UUO animals. The changes in apical membrane voltage and GT upon addition of luminal amiloride and Ba2+, and the changes in VB upon addition of bath ouabain, were also decreased in the CCD from UUO animals compared with control animals. Pretreatment of renal decapsulation also partially corrected the above abnormalities seen in UUO animals, whereas it had no effect in control animals. The transference numbers for Cl-(tc) and K+ (tK) in the basolateral membrane were, respectively, increased and decreased in the CCD from UUO animals compared with control animals. Pretreatment of renal decapsulation also partially corrected the changes in tc, and tK seen in UUO animals, whereas it had no effect in control animals. We conclude that, in UUO animals, renal decapsulation partially corrects the inhibition of apical Na+ and K+ conductances as well as basolateral Na+-K+ pump activity and relative K+ conductance seen after UUO, whereas in control animals it has no

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Hyperkalemic Distal Renal Tubular Acidosis Associated with Obstructive Uropathy

Cited by 252 publications

References 19 publications

Medication Treatment Complexity and Adherence in Children with CKD

Medication Treatment Complexity and Adherence in Children with CKD

Electrical properties of the rabbit cortical collecting duct from obstructed and contralateral kidneys after unilateral ureteral obstruction.

Electrical properties of the rabbit cortical collecting duct from obstructed kidneys after unilateral ureteral obstruction. Effects of renal decapsulation.

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