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  • Aldosterone  (2)
  • Key words Nephrotic syndrome  (1)
  • Springer  (3)
  • 1
    ISSN: 1432-1440
    Keywords: 18-OH-Corticosteron ; Aldosteron ; Radioimmunoassay ; Hypertonie ; Primärer Hyperaldosteronismus ; 18-OH-corticosterone ; Aldosterone ; Radioimmunoassay ; Hypertension ; Primary hyperaldosteronism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Aldosterone-18-glucuronide, free aldosterone, free 18-OH-deoxycorticosterone, and tetrahydroaldosterone radioimmunoassays were performed in urine samples from normal subjects, as well as from patients with essential hypertension and primary hyperaldosteronism. The aldosterone-18-glucuronide measurements were made on 1119 urine samples, with and without chromatographic separation, with antisera raised against 3 different types of aldosterone antigens. Good correlations were found between the values obtained with the different methods. However, the values measured without chromatography were usually higher and individual discrepancies between results obtained with and without chromatography were observed. The antiserum raised against an aldosterone-3-oxime antigen produced the most reliable results without prior chromatography, but the values were still higher than after chromatography in 4.33% of 854 cases. These values may be clinically misleading, and we therefore recommend the aldosterone-18-glucuronide estimation without chromatography as a screening method only. When the results of the aldosterone-18-glucuronide, free aldosterone, free 18-OH-deoxycorticosterone, and tetrahydroaldosterone assays were compared, free aldosterone was found to correlate the best with the results of all other assays. There were also correlations among the other assays. The aldosterone-18-glucuronide estimation is currently the most frequently used assay. This study revealed, however, that in patients with essential hypertension and primary aldosteronism, normal aldosterone-18-glucuronide levels can be accompanied by high free aldosterone and tetrahydroaldosterone levels. We conclude, therefore, that the aldosterone-18-glucuronide assay may not be sufficient to select all patients with hyperaldosteronism. Additionally, a radioimmunoassay of urinary free 18-OH-corticosterone was developed and used as an aid in the aldosterone diagnosis. The excretion levels were 1.5–6.5, with a mean value (± SD) of 4.0±1.44 µg/24 h. These values also correlated with the different aldosterone measurements, and correlated best with the free aldosterone values.
    Notes: Zusammenfassung Aldosteron-18-Glucuronid Bestimmungen wurden von Urinproben (n=1119) vor und nach Chromotagraphie mit Hilfe von Antikörpern durchgeführt, die gegen drei verschiedene Typen von Aldosteron Antigenen erzeugt wurden. Die Werte vor und nach Chromatographie zeigten eine hochsignifikante Korrelation. Dennoch lagen die Bestimmungen, die ohne einen Isolierungsschritt vorgenommen wurden, im allgemeinen höher und in Einzelfällen gab es Dissoziationen der Werte. Mit einem Aldosteron-3-oxim-Antiserum wurden die zuverlässigsten Bestimmungen ohne Chromatographie erzielt. Auch mit diesem Antiserum wurden jedoch überhöhte Werte in 4,33% der Tests (n=854) bestimmt, die als klinisch irreführend bezeichnet werden können. Die Technik ohne Chromatographie ist deswegen nur für Screening-Zwecke akzeptabel. Aldosteron-18-Glucuronid, freies Aldosteron, freies 18-Hydroxycorticosteron, freies 18-Hydroxydeoxycorticosteron und Tetrahydroaldosteron wurden radioimmunologisch aus Urinproben von Normalpatienten, von Patienten mit essentieller Hypertonie und mit primärem Hyperaldosteronismus bestimmt. Die Resultate wurden untereinander verglichen. Die verschiedenen Größen korrelierten signifikant miteinander, doch die Korrelationskoeffizienten waren sehr unterschiedlich. Die besten Korrelationen wurden errechnet, wenn freie Urinaldosteron Werte mit den anderen Größen verglichen wurden. Die Bestimmung von Aldosteron-18-Glucuronid ist zur Zeit die am meisten durchgeführte Bestimmung. Bei einer Gruppe von Patienten mit essentieller Hypertonie und auch bei Patienten mit primärem Hyperaldosteronismus waren die Aldosteron-18-Glucuronid Werte innerhalb des Normbereiches, während die Exkretion des freien Urin-Aldosterons und des Tetrahydroaldosterons erhöht war. Wir schließen daraus, daß die Bestimmung des Aldosteron-18-Glucuronids für die Diagnose einer Aldosteron Hyperproduktion nicht immer ausreicht. Es wurde zusätzlich ein Assay für freies 18-Hydroxycorticosteron im Urin entwickelt, um die Aldosteron Diagnostik zu stützen. Der Normalbereich war 1,5–6,5 µg/24 h. Der Durchschnitt (± SD) lag bei 4,0±1,44 µg/24 h. Diese Werte korrelieren besonders gut mit den Bestimmungen von freiem Aldosteron.
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  • 2
    ISSN: 1432-198X
    Keywords: Key words Nephrotic syndrome ; Glucocorticoid receptors ; Glucocorticoids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The variable response of patients with idiopathic nephrotic syndrome (NS) to glucocorticoid (GC) treatment has not been explained. Earlier studies indicated that the response is limited by cellular GC receptors. We investigated these receptors in mononuclear leukocytes of 28 pediatric patients with NS divided into three groups: steroid-sensitive in relapse, steroid-sensitive in remission, and steroid-resistant. Density and binding affinity of GC receptors were determined by a dexamethasone binding assay; no significant differences were found between the three patient groups and between these and healthy controls, although a few patient values fell outside the range of controls. Total and free plasma concentrations of cortisol were low in all three patient groups. A weak positive correlation was found between the number of GC receptors and total plasma cortisol (r=0.36, P=0.03). The results suggest that factors other than GC receptors that mediate the cellular effects of GC are involved in the variable response of NS patients to GC.
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  • 3
    ISSN: 1530-0358
    Keywords: Proctocolectomy ; Ileostomy ; Ulcerative colitis ; Familial adenomatous polyposis ; Aldosterone ; Renal function ; Acid-base balance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Restorative proctocolectomy is a standard procedure in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. The radical removal of the colorectum with construction of an ileostomy often results in high stoma losses. These may lead to changes in the electrolyte and acid-base balance and to alterations in renal and suprarenal gland function. METHODS: In this study 33 patients who received an ileoanal pouch before and after proctocolectomy were investigated at different time intervals for electrolyte changes, alteration of the acid-base balance, kidney function, and hormonal changes of the suprarenal glands. Measurements were performed before proctocolectomy, ten days after proctocolectomy with ileal pouch-anal anastomosis under protective loop ileostomy, before ileostomy closure, and 6 to 12 months after ileostomy closure. Neither acute renal failure nor other vital complications were observed. RESULTS: Statistical analysis showed a significant decrease of urine pH to 5.4±0.22 (before ileostomy closure) and metabolic acidosis (pH 7.32±0.04; base excess −1.3±5.6 (before ileostomy closure)). Likewise, we found a decrease in renal clearance to 86 ml/minute (before ileostomy closure) without signs of tubular damage. The most important change during the phase with ileostomy was a functional secondary hyperaldosteronism with aldosterone levels of 63.2±70.8 ng/dl (before ileostomy closure). In comparison with preoperative levels, there was a ten-fold increase in mineralocorticoid adrenal activity. Additionally, during the period with protective ileostomy, the hepatic synthesis of aldosterone-18-glucuronide was only slightly increased, and the cortisol/cortisone ratio was extremely decreased. CONCLUSIONS: These results show that restorative proctocolectomy with ileal pouch-anal anastomosis and protective loop ileostomy significantly influences fluid, electrolyte, and acid-base balance. Functional secondary hyperaldosteronism is of central importance for subsequent renal recompensation. Approximately one-half year after ileostomy closure, the endogenous hormones with mineralocorticoid effects returned to normal levels.
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