Download Acute Renal Failure: Pathophysiology, Prevention, and by Vittorio E. Andreucci (auth.), Vittorio E. Andreucci (eds.) PDF

By Vittorio E. Andreucci (auth.), Vittorio E. Andreucci (eds.)

`No doubt than it good merits its position within the library of the younger and no more younger nephrologists either in general within the medical perform or in research.'
Nephron (1986)
`The publication is an updated and important compendium of present wisdom within the medical administration of acute renal failure.'
Journal of the Royal Society of drugs, seventy eight (1985)

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18 vat ions represent clear evidence of tubular obstruction. , intrarenal infusion of PGE b bradykinin, furosemide, or mannitol) (14, 119, 121, 128, 149} may be due to flushing out of cellular debris and prevention of intratubular casts formation (15}. Thus, 30-minute pretreatment with 5% mannitol prevented the rise in ITP during microperfusion of tubules in dogs with unilateral post-ischemic kidney (119}. It is more difficult to explain the improvement in GFR obtained by pretreatment with propranolol in rats 1 to 3 hours after 60-minute renal artery clamping; since RBF did not increase, while ITP increased less than in unpretreated rats, it has been stated that attenuation of tubular obstruction by the drug (by a still unknown mechanism) may account for the partial protection against post-ischemic ARF (148}.

C. d. e. f. g. h. [242-244}, and All is formed by an intracellular mechanism independent from the extracellular RAS [245}. All has been shown to decrease RBF [246}. All decreases GFR [2l}. All has been demonstrated to reduce K f [21]; even the reduction of K f observed after PTH, PGE 20 PGI 20 and cAMP seems to be mediated by All [47]. After i. v. injection in rats, tritiated All has been located by autoradiography in the glomerular mesangial cells [247]. Scanning electron microscopy has demonstrated a marked shrinkage of glomerular tufts following All administration in rats [248} presumably due to the contractile myofilaments contained in glomerular mesangial cells; the resulting decrease of the surface area of the glomerular capillaries may well account for the reduction in K f • It seems that only All and arginine vasopressin are capable of stimulating mesangial cell contraction in vitro [249].

The tendency of a return to anatomical and functional integrity of tubular epithelium at this stage is further demonstrated by (a) the significant reduction of UNa and FENa; (b) the normalization of urine output, and (c) the complete recovery from the ipsilateral final urine of 3H-inulin microinjected in proximal tubules. From the second to the eighth weeks, the rise in GFR was gradual and paralleled the increase in RBF and in GCP, the latter accounting for the rise in afferent EFP (ITP remaining normal); meanwhile UNa and FENa completely normalized.

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