Ulinastatin Gives Rise to an Effectual Diuresis in Oliguric Acute Renal Failure

Abstract

Dear Sir, Ulinastatin with a molecular weight of 67,000 is a trypsin inhibitor which was purified from fresh human urine. It has a broad spectrum of enzyme activity inhibi tion: trypsin, chymotrypsin, elastase, etc. [1][2][3]. It has already been reported that ulinastatin had effectiveness in the treatment of pancreatitis and traumatic, hemor rhagic, and endotoxic shock [4,5].The effects of ulinastatin on oliguric acute renal fail ure were assessed in this study. Five cases of oliguric acute renal failure were treated. There were 3 males and 2 females, age ranging from 58 to 78 years. The mean age was 69.0±(SE)4.0 years. Serum creatinine and blood urea nitrogen levels ranged from 2.0 to 8.4 and from 71 to 121 m g/dl, respectively. The mean of serum creatinine and blood urea nitrogen levels were 5.4± 1.2 and 90 ± 10 mg/dl. Mean (± S D ) arterial pressure and heart rate were 88.6 ±23.0 mm Hg and 75 ± 24 beats/min, re spectively. For these 5 cases, an intravenous bolus injec tion of ulinastatin (20 x 10I * * 4 U) in saline (2 ml) was admin istered [6], Before and after the ulinastatin injection, other medications for treatment of oliguric acute renal failure were continued. Then urinary volume, blood pres sure, and heart rate were measured every I h. Urinary volumes were corrected with transfusion volumes. The corrected urinary volumes (cUV), calculated using the equation cUV = UV (ml/h) transfusion volume (ml/h), are presented in figure 1. The cUV values were signifi cantly higher than the values before ulinastatin injection. Furthermore, the increased cU V had been retained for at least 4 hours. On the other hand, mean arterial pressure and heart rate did not significantly change after ulinas tatin injection.Ulinastatin 20X104U

Intra-alveolar urinary trypsin inhibitor cannot inhibit polymorphonuclear elastase activity in the lung in postsurgical patients with acute respiratory distress syndrome

“…2,3,[5][6][7] In Japan, UTI is used clinically as a protease inhibitor, named "ulinastatin" (Mochida Pharmaceutical, Tokyo, Japan), for treating acute pancreatitis, circulatory collapse, and renal dysfunction. [24][25][26] In addition to these illnesses, several Japanese reports have documented the effect of the transbronchial administration of ulinastatin on various types of acute respiratory failure including ARDS. 27 Although this treatment has not been established, the measurement of UTI and PMNE concentrations in the BALF after the transbronchial administration of ulinastatin should be conducted to evaluate this therapy.…”

Effect of ulinastatin on the rocuronium-induced neuromuscular blockade

“…The times to the return of PTC, T1, T2, T3 and T4 responses were shortened because the protease inhibitor homolgues increase the release of acetylcholine (Ach), in response to motor nerve stimulation [10]. It has been demonstrated that ulinastatin increases both the liver blood flow [7] and the urine output [8]. Rocuronium is eliminated mainly through the liver and partly through the kidney [4]; therefore, the hepatic elimination of rocuronium might be enhanced by ulinastatin, which accelerates the recovery from neuromuscular block.…”

“…Because ulinastatin increases both liver blood flow [7] and urine output [8], and rocuronium is eliminated mainly through the liver and partly through the kidney [4], hepatic elimination of rocuronium might be enhanced by ulinastatin. A previous study on protease inhibitor homologues showed that ulinastatin releases acetylcholine at the neuromuscular junction, and this may cause resistance to rocuronium [9].…”

Drugs to facilitate recovery of neuromuscular blockade and muscle strength

“…Furthermore, it has been reported that ulinastatin increases hepatic blood flow and urine volume [8][9][10][11]. Vecuronium is eliminated mainly in the liver and partially in the kidney [12][13][14][15]. Therefore, administration of ulinastain results in an increase in hepatic and renal clearance of vecuronium.…”