Urinary Concentrating Ability in Pregnant Women With Asymptomatic Bacteriuria*

Kaitz, Alan L.

doi:10.1172/jci104363

Cited by 84 publications

(23 citation statements)

References 25 publications

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“…A concentrating defect may be the earliest functional abnormality in pyelonephritis, antedating a reduc tion in glomerular filtration rate (6,19). These observations are sup ported by the demonstration in the present experiment and in the study of experimental pyelonephritis reported by Beck and his associates (1) that maximal urine osmolality may be reduced before alterations in glomerular architecture or in glomerular filtration rate are apparent.…”

Section: Discussionsupporting

confidence: 76%

Functional Abnormalities in Experimental Pyelonephritis

Gonick¹,

Goldberg²,

Rubini³

et al. 1965

Nephron

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(1) Concentrating ability was studied in rats with experimental pyelonephritis. Maximal urinary concentration was shown to be reduced as early as one week after introduction of infection and persisted unchanged up to 21 weeks with repetitive injections of bacteria. (2) Glomerular filtration rate was unaltered throughout the study period. PAH clearance fell in the repetitively injected animals. (3) Sodium content of the renal papilla remained normal but urea content fell in the one-week singly injected and 21-week repetitively injected animals. (4) Histological examination showed progressive dilatation of residual collecting ducts. (5) It is suggested that the concentrating defect in early experimental pyelonephritis is due to impaired permeability of the collecting ducts to urea and water.

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Section: Discussionsupporting

confidence: 76%

Functional Abnormalities in Experimental Pyelonephritis

Gonick¹,

Goldberg²,

Rubini³

et al. 1965

Nephron

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“…The kidneys contained relatively few organisms 24 hr after challenge but by 48-72 hr, multiplication to titers over 10' per kidney had occurred. The numbers of organism in the kidneys remained high (over 10' per kidney) for as long as 12 wk in rats infected with enterococci whereas titers dropped in rats infected with staphylococci and most 2 kidneys were sterile by 4 wk. The mortality rate was about 10% after inoculation of staphylococci and about 5% after injection of enterococci.…”

Section: Resultsmentioning

confidence: 96%

“…A defect in the urinary concentrating mechanism may be the earliest functional abnormality in pyelonephritis in humans (1,2). Two studies (3,4) have clearly demonstrated a urinary concentrating defect early in experimental pyelonephritis produced by intravenous inoculation of gram positive cocci (staphylococci and enterococci), but there is little information available on concentrating ability in early experimental pyelonephritis caused by gram negative bacilli.…”

Section: Introductionmentioning

confidence: 99%

Urinary concentrating ability in early experimental pyelonephritis

Kaye¹,

Rocha²

1970

J. Clin. Invest.

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A B S T R A C T The effect of early bilateral pyelonephritis on urinary concentrating ability was studied in rats injected intravenously with enterococci or Staphylococcus aureus and in rats inoculated with Escherichia coli into the medullae of both kidneys. The mean maximum urinary osmolality of normal rats was 2352 mOsm/kg of water. Inoculation of E. coli caused reversible pyelonephritis with sterilization of the kidneys within 12 wk. By 1 day after injection the mean maximum urinary osmolality had decreased to about 1100 mOsm, remained at this level for 3 wk, and then rose to normal by 12 wk. After injection of enterococci and staphylococci, the mean maximum urine osmolality decreased over 3-4 days to about 1000 and 800 mOsm respectively. In the enterococcal infection (which is chronic) the maximum urine osmolality remained about 1200 mOsm for at least 12 wk whereas in the staphylococcal infection (which is reversible) the osmolality gradually rose.Antimicrobial therapy of E. coli renal infection with colistimethate sodium and S. aureus infection with ampicillin rapidly reduced bacterial titers in the kidneys with an associated rise in maximum urinary osmolality. Therapy of enterococcal renal infection with ampicillin produced less impressive decreases in bacterial titers in the kidneys and little or no improvement in urinary concentrating ability. With antimicrobial therapy or with the self-limited infections, the rate of increase in concentrating ability was directly correlated with the rate of decrease of bacterial titers. However, there was poor correlation between histological findings in the kidneys and urinary concentrating ability.These studies demonstrate that early experimental pyelonephritis is associated with a concentrating defect This work was reported in part in abstract form; Kaye, D., and H. Rocha. 1969. Urine osmolality in experimental pyelonephritis. J. Clin. Invest. 48: 43a.

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“…However, pregnant women 1Abbreviations used in this paper: ADH, antidiuretic hormone, DI rat, homozygous Brattleboro animal with hereditary diabetes insipidus; PAVP, plasma arginine vasopressin; Pco2, carbon dioxide tension; PH,O, plasma water content; PHCO3, plasma bicarbonate; PNa, plasma sodium, Posm, plasma osmolality. appear to concentrate and dilute their urine appropriately when subjected to water loading or dehydration (3)(4)(5)(6). Such data demonstrate that there are alterations in water handling during gestation and prompted the present study of osmoregulation in the pregnant rat.…”

mentioning

confidence: 92%

Osmoregulation during Pregnancy in the Rat

Dürr¹,

Stamoutsos²,

Lindheimer³

1981

J. Clin. Invest.

125

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AB S T R A C T Osmoregulation was studied in near term and age-matched Sprague-Dawley rats. Basal plasma osmolality (Posm) and plasma sodium (PNa) were 281+3 mosmol/kg and 134+3 meq/liter, respectively, on the 20th gestational day compared with 292+±3 mosmol/kg and 140+1 meq/liter in virgin animals (P < 0.001), whereas Purea and plasma water content were similar in pregnant and control rats. These differences could not be reproduced in animals receiving progesterone, estrone, or a combination of progesterone and estradiol for 2 wk.Pregnant and control rats were deprived of water for changes (A%) were significantly greater in the gravid animals (P < 0.01). Therefore, Posm was increased without concomitant volume depletion by intraperitoneal hypertonic saline. Again PAVP VS. Posm correlated significantly (r > 0.9; P < 0.001) in each group, and the apparent threshold was 14 mosmol lower in pregnant animals. Diluting ability, tested by oral water loading, was not impaired in the pregnant animals which excreted a 30 ml/kg load as well as controls. Also, chronically hydrated virgin animals whose fluid intake was more than twice that of pregnant rats (for 19 d) did not lower their Posm.In separate studies homozygous Brattleboro rats, which produce no endogenous vasopressin, were also shown to have a decreased Posm (pregnant 292 +4 mosmol/kg; virgin 310+6 mosmol/kg P < 0.001), but unchanged Uosm during pregnancy.Data demonstrate a resetting ofthe osmostat in gravid Sprague-Dawley rats as Posm and the threshold for AVP secretion both decrease significantly during gestation in this species. Studies in homozygous Brattleboro animals with hereditary diabetes insipidus suggest that the osmotic threshold for thirst is reset as well. INTRODUCTION Plasma osmolality decreases during normal human pregnancy to values that range 5-10 mosmol/kg below that of nonpregnant women (1-3). This decrement is apparent by the 6th gestational wk and is sustained until term. If such a reduction in osmolality occurred in a nongravid subject she would cease secreting antidiuretic hormone (ADH)l and enter a state of con-

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Urinary Concentrating Ability in Pregnant Women With Asymptomatic Bacteriuria*

Cited by 84 publications

References 25 publications

Functional Abnormalities in Experimental Pyelonephritis

Functional Abnormalities in Experimental Pyelonephritis

Urinary concentrating ability in early experimental pyelonephritis

Osmoregulation during Pregnancy in the Rat

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