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1 Department of Pediatrics,
We investigated the effects of hypotonic
saline-induced modifications of extracellular volume and sodium
handling on the renal and metabolic response to amino
acids (AA). Renal hemodynamics (Inutest, p-aminohippurate
clearance), plasma AA, and glucagon levels, as well as urea and sodium
excretion, were studied in seven adult volunteers infused for 2 h, on
six separate occasions, according to the following protocols:
1) high-AA solution (300 mg · min
1 · 1.73 m
2);
2) low-AA solution (150 mg · min
1 · 1.73 m
2);
3) low AA + 2,000 ml/1.73 m2 of 0.23% saline solution;
4) high AA + 0.23% saline;
5) high AA + 0.45% saline; and
6) 0.45% saline alone. The
glomerular filtration rate (GFR) rise induced by the high-AA solution
was similar to that induced by the low-AA solution (
GFR = +24 ± 6 and +20.2 ± 7 ml · min
1 · 1.73 m
2, respectively), whereas
the plasma AA and glucagon levels and urea excretion rate increases
were related to AA dose. The addition of 0.23% saline to the low-AA
solution and of 0.45% saline to the high-AA solution blunted the renal
hemodynamic response (
GFR = +6.6 ± 10.1 and +11.4 ± 8.3 ml · min
1 · 1.73 m
2, respectively) without
modifying the pattern of plasma AA and glucagon levels and urea
excretion observed with the AA infusion alone. Urinary sodium excretion
increased from baseline with each protocol and rose even further when
saline was added to AA. A negative correlation
(r =
0.38,
P < 0.05) was found between the changes from basal values in GFR and those in sodium excretion rate
with high-AA infusion at different levels of sodium concentration. These data suggest that AA-induced hyperfiltration might be blunted by
hypotonic saline infusion, possibly through an acute modification of
renal sodium handling and extracellular volume.
renal hemodynamics; urea excretion; glucagon; sodium handling
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