Thesis (doctoral)--University of Uppsala, 1981. / Includes bibliographical references (p. 15-17).

Diss. (sammanfattning) Göteborg : Göteborgs universitet , 2007. / Härtill 5 uppsatser.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A guanilina e a uroguanilina foram recentemente descobertas, respectivamente, no intestino e na urina, (Currie et al., 1992; Hamra et al., 1993). Fazem parte da famÃlia de peptÃdeos que ativam a guanilato ciclase de membrana (GC-C), aumentando os nÃveis intracelulares de cGMP (Schulz et al., 1990). EstÃo presentes em diversos tecidos, como respiratÃrio, linfonodos, testÃculos, cÃrebro e medula adrenal (Field et a.l., 1978; Forte et al., 1988, 1989; Hamra et al., 1993; Schulz et al., 1992). Foi comprovado que adicionando uma lisina na porÃÃo N-terminal, obtÃm-se um anÃlogo mais estÃvel e potente que a guanilina. O objetivo desse estudo à pesquisar os efeitos renais de um novo anÃlogo, ser-thr-lys-guanilina em sistema de perfusÃo. Os rins foram perfundidos com a soluÃÃo de Krebs-Henseleit modificada com 6g% de albumina bovina. Os dados foram comparados atravÃs de teste t de Student e ANOVA, com significÃncia p<0,05. Na dose de 0,1 Âg/mL, esse peptÃdeo apresentou efeitos similares aos da uroguanilina, na dose de 0,5 Âg/mL, em todos os parÃmetros testados. Ambas causaram aumento na pressÃo de perfusÃo (PP: de 101,5Â3,7 para 111Â2,9mmHg; de 101,2Â2,6 para 113,4Â2,5mmHg), no fluxo urinÃrio (FU: de 0,158Â0,016 para 0,223Â0,01 mL.g-1.min-1; de 0,16Â0,016 para 0,226Â0,2mL.g-1.min-1) e diminuiÃÃo no transporte tubular total e proximal de sÃdio (%TNa+: de 0,774Â0,06 para 0,724Â0,035; de 0,735Â0,065 para 0,773Â0,084), potÃssio (%TK+: de 66,89Â2,77 para 47,29Â3,34; de 63,54Â3,82 para 42,54Â8,14) e cloreto (%TCl-: de 85,69Â1,19 para 73,59Â2,63). Esses resultados foram similares aos previamente descritos apÃs a administraÃÃo da toxina termo-estÃvel da Escherichia coli (STa), guanilina, uroguanilina e lys-guanilina no mesmo sistema (Lima et al., 1992; Fonteles et al., 1996 e 1998). A dose maior (1 Âg/mL) causou aÃÃo antidiurÃtica (FU: de 0,165Â0,004 para 0,111Â0,009mL.g-1.min-1) e nenhum efeito sobre o transporte de sÃdio, embora a diminuiÃÃo na reabsorÃÃo tubular de potÃssio (%TK+: de 72,29Â1,2 para 49,73Â6,75) e cloreto (%TCl-: de 85,96Â0,79 para 81,9Â1,47) continuassem presentes. Nesta dose, nÃo apenas bloqueou o efeito diurÃtico da uroguanilina, como continuou causando um efeito antidiurÃtico significativo (FU: de 0,168Â0,004 para 0,116Â0,006). No entanto, nÃo foi capaz de bloquear os efeitos natriurÃticos da uroguanilina (%TNa+: de 85,35Â2,55 para 79,92Â1,05). O mecanismo de aÃÃo renal preciso dos peptÃdeos da famÃlia das guanilinas ainda nÃo foi completamente esclarecido. Sabe-se que esses peptÃdeos se ligam aos receptores GC-C (Schulz et al., 1990), porÃm hà indÃcios de que existam outras vias de aÃÃo renal, independentes desse receptor. Hà ainda a possibilidade de que haja duas entidades agindo de modo antagÃnico no sistema. Talvez haja a necessidade de isolÃ-los. A descoberta dos peptÃdeos da famÃlia das guanilinas promoveu avanÃos significativos na compreensÃo da regulaÃÃo endÃgena dos transportes de Ãgua e eletrÃlitos. O completo esclarecimento do seu mecanismo de aÃÃo renal oferece perspectivas reais para o tratamento de doenÃas como a hipertensÃo arterial. / Guanylin and uroguanylin are members of a family of peptides that stimulates cGMP production in several organic tissues, as intestine, kidney, airway, linfonodes, testis, brain and adrenal medulla (Field et a.l., 1978; Forte et al., 1988, 1989; Hamra et al., 1993; Schulz et al., 1992). Their 15 amino acid structures have been identified from rat intestine and opossum urine, respectively (Currie et al., 1992; Hamra et al., 1993), and they seem to be the link between intestine and kidney functions in controling blood pressure, as the âintestinal natriuretic hormoneâ suggested by some authors (Carey, 1978; Lennane et al., 1975). It was demonstrated that a Lysine-1 analog of guanylin is a more potent natriuretic and kaliuretic peptide. The aim of this study was to evaluate the renal effects of a novel analog of guanylin: ser-thr-lys-guanylin. Its effects were examined using isolated perfused kidneys from Wistar rats. All experiments were preceded by a 30 minutes internal control period and an external control group (C), in which the kidneys were perfused only with Krebs-Henseleit solution containing 6g% of a previously dialysed bovine albumine serum. The data was analyzed by Student t-test and ANOVA. The level of significance was set at p<0,05. Ser-thr-lys-guanylin, at the lowest dose (0.1 Âg/mL) and uroguanylin (0.5Âg/mL) caused similar effects. Both groups were able to increase perfusion presure (PP: 101.5Â3.7 to 111Â2.9mmHg; 101.2Â2.6 to 113.4Â2.5 mmHg), urinary flow (UF: 0.158Â0.016 to 0.223Â0.019 mL.g-1.min-1; 0.16Â0.016 to 0.226Â0.2mL.g-1.min-1) and to decrease sodium (%TNa+: 0.774Â0.06 to 0.724Â0.035; 0.735Â0.065 to 0.773Â0.084), potassium (%TK+: 66.89Â2.77 to 47.29Â3.34; 63.54Â3.82 to 42.54Â8.14) and cloride (%TCl-: 85.69Â1.19 to 73.59Â2.63) tubular reabsorption. Similar effects were also found in response to the Escherichia coli heat-stable enterotoxin (STa), guanylin, uroguanylin and lys-guanylin in the same system (Lima et al., 1992; Fonteles et al., 1996 e 1998). However, a greater dose (1Âg/mL), not only caused signifcantly decrease in the urinary flow (UF: 0.165Â0.004 to 0.111Â0.009 mL.g-1.min-1), but was also able to block the diuretic effects of uroguanylin (UF: 0.168Â0.004 to 0.116Â0.006 mL.g-1.min-1), although it still decreased potassium (%TK+: 72.29Â1.2 to 49.73Â6.75) and cloride(%TCl-: 85.96Â0.79 to 81.9Â1.47) tubular reabsorption. The precise renal mecanism of action of this family of peptides has not yet been fully elucidated. Deletion of GC-C genes in transgenic mice reveals that intestinal fluid secretion responses to STa are completely lost (Schulz et al., 1997 & Mann et al., 1997), but the natriuretic responses to STa and uroguanylin are retained (Carrithers et al., 1999), suggesting that other receptors are envolved. There is a possibility that there are to peptides causing antagonic effects. Further isolation may be necessary. Further studies are required to elucidate the specific renal mechanism of action of this new peptide. The discovery of guanylin and its family has promoted significant advances in the understanding of endogenous control of salt, water and eletrolites. The study of its analogs in perfused rat kidneys could help in elucidating their specific renal mecanism of action and bring great perspectives in the control of blood pressure.

During the last ten years, several patients have presented to the Renal Unit of Groote Schuur Hospital with acute renal failure following the use of traditional (N'anga or Gqirha) medication. The history together with abnormal liver-function tests and renal failure was thought to be suggestive of a toxic aetiology. The specific toxin however remained unknown, until during the admission of one patient, a relative brought in the medication, analysis of which revealed a high concentration of potassium dichromate. Subsequently elevated levels of chromium were demonstrated by atomic absorption spectrometry in the blood and urine of this patient. Following this case there have been six further cases of acute renal failure resulting from use of dichromate containing traditional remedies. These remedies were obtained from a variety of sources including street-hawkers, herbal chemists, and traditional healers. Clinical and laboratory data relating to these seven patients will be presented.

1. Little work has been done on the response of regular haemodialysis patients to dynamic exercise. A systematic study of exercise capacity and the underlying mechanisms is of particular importance because these patients are encouraged to return to as normal a way of life as possible. Accordingly, a select group of healthy young male patients and a group of older males have been studied during submaximal cycling. The young male patients were compared to a closely matched sedentary control group. The 17 subjects discussed represent the fittest of 40 patients tested. 2. In both groups there was decreased work capacity associated with disproportionate tachycardia, which was not obvious at rest. Blood pressure was measured with a sphygmomanometer. During exercise there was a striking rise in the systolic blood pressure in about half the patients from currently acceptable resting levels. This occurred in the absence of any clinical circulatory overload. Mild hyperventilation and disproportionate lactic acidosis was seen towards peak exercise, probably because, in spite of the decreased work capacity, the patients were much closer to their maximum performance. However, the limiting factors were clearly circulatory and not respiratory. 3. A number of the younger male patients were more intensively studied to determine why some remained relatively 'normotensive' during exercise while others developed systolic hypertension. Total blood volume, total body water and plasma renin activity were measured at rest. It was found that the 'normotensive' patients had normal body volumes and normal to high plasma renin activity, while the hypertensive subgroup had increased volumes and normal to low plasma renin activity. Thus, in these patients the blood pressure responses to exercise were largely volume dependent, albeit at a subclinical level. 4. Cardiac output was measured at rest and during exercise. All patients developed a variable hyperkinetic circulation during exercise which was not apparent at rest. The patients were all anaemic and (xi) their cardiac output response was very like that described in patients with anaemia unassociated with renal disease. However, some patients with striking anaemia developed a less hyperkinetic circulation than others who were not so anaemic. When the body volume and the blood pressure response on exercise were considered, those patients who were normovolaemic and 'normotensive' developed a hyperkinetic circulation on exercise appropriate to their degree of anaemia. Those with subclinical volume overload and a hypertensive response to exercise developed a much less striking hyperkinetic circulation, suggesting that the blood pressure and volume excess was depressing the anticipated cardiac output response to their underlying anaemia. 5. One patient with an arteriovenous shunt was studied twice, initially when hypervolaemic with a haemoglobin of 9,1gm/100 ml and again after ultrafiltration when he was normovolaemic but his haemoglobin had risen to 12,5 gm/100 ml. On the first occasion his cardiac output response was moderately hyperkinetic but he developed increasing hypertension with a high calculated total peripheral resistance. On the second occasion his cardiac output response fell within the normal range, his blood pressure was lower but not normal and his calculated total peripheral resistance was even higher than before. Thus, the blood pressure of these volume dependent patients is due to a high total peripheral resistance, but may not simply be on the basis of 'waterlogging' of the peripheral vasculature. Some other factor, such as structural thickening, must be considered. 6. It is suggested that the combination of tachycardia and hypertension which develop on mild exertion and which may not be obvious at rest, is the most potent cause of the increased cardiovascular mortality seen in dialysis patients. Simple exercise testing will reveal those with subclinical volume overload who are most at risk. It was striking that in the two groups tested those who developed striking hypertension on exercise were usually older, between 35 and 50 years. This accelerated aging of their vascular tree would correspond with recent data showing that dialysis mortality increases with age, and is about a decade earlier than in the general population. It is suggested that a more aggressive policy be adopted towards blood pressure fluctuations and that the resting blood pressure should be kept below 140/90 mm Hg at all times, if necessary by complementing ultrafiltration with drug therapy and/or bilateral nephrectomy at an early stage. 7. Thus simple exercise testing with blood pressure recordings not only serves as a yardstick of physical rehabilitation and long-term follow-up, but may also reveal or magnify abnormalities not obvious at rest.

During the last ten years, several patients have presented to the Renal Unit of Groote Schuur Hospital with acute renal failure following the use of traditional (N'anga or Gqirha) medication. The history together with abnormal liver-function tests and renal failure was thought to be suggestive of a toxic aetiology. The specific toxin however remained unknown, until during the admission of one patient, a relative brought in the medication, analysis of which revealed a high concentration of potassium dichromate. Subsequently elevated levels of chromium were demonstrated by atomic absorption spectrometry in the blood and urine of this patient. Following this case there have been six further cases of acute renal failure resulting from use of dichromate containing traditional remedies. These remedies were obtained from a variety of sources including street-hawkers, herbal chemists, and traditional healers. Clinical and laboratory data relating to these seven patients will be presented.

Thematic Paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services. LIRV has E-Thesis 0038 ; please contact circulation services.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 65-69).

Thesis (Ph. D.)--University of Virginia, 2007. / Title from title page. Includes bibliographical references. Also available online through Digital Dissertations.

Thesis (Ph. D.)--University of Virginia, 2008. / Title from title page. Includes bibliographical references. Also available online through Digital Dissertations.