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2015 ; 4
(3
): 423-37
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Changes in urinary excretion of water and sodium transporters during amiloride
and bendroflumethiazide treatment
#MMPMID26167467
Jensen JM
; Mose FH
; Kulik AE
; Bech JN
; Fenton RA
; Pedersen EB
World J Nephrol
2015[Jul]; 4
(3
): 423-37
PMID26167467
show ga
AIM: To quantify changes in urinary excretion of aquaporin2 water channels
(u-AQP2), the sodium-potassium-chloride co-transporter (u-NKCC2) and the
epithelial sodium channels (u-ENaC) during treatment with bendroflumethiazide
(BFTZ), amiloride and placebo. METHODS: In a randomized, double-blinded,
placebo-controlled, 3-way crossover study we examined 23 healthy subjects on a
standardized diet and fluid intake. The subjects were treated with amiloride 5
mg, BFTZ 1.25 mg or placebo twice a day for 4.5 d before each examination day. On
the examination day, glomerular filtration rate was measured by the constant
infusion clearance technique with (51)Cr-EDTA as reference substance. To estimate
the changes in water transport via AQP2 and sodium transport via NKCC2 and ENaC,
u-NKCC2, the gamma fraction of ENaC (u-ENaC?), and u-AQP2 were measured at
baseline and after infusion with 3% hypertonic saline. U-NKCC2, u-ENaC?, u-AQP2
and plasma concentrations of vasopressin (p-AVP), renin (PRC), angiotensin II
(p-ANG II) and aldosterone (p-Aldo) were measured, by radioimmunoassay. Central
blood pressure was estimated by applanation tonometry and body fluid volumes were
estimated by bio-impedance spectroscopy. General linear model with repeated
measures or related samples Friedman's two-way analysis was used to compare
differences. Post hoc Bonferroni correction was used for multiple comparisons of
post infusion periods to baseline within each treatment group. RESULTS: At
baseline there were no differences in u-NKCC2, u-ENaC? and u-AQP2. PRC, p-Ang II
and p-Aldo were increased during active treatments (P < 0.001). After hypertonic
saline, u-NKCC2 increased during amiloride (6% ± 34%; P = 0.081) and increased
significantly during placebo (17% ± 24%; P = 0.010). U-AQP2 increased
significantly during amiloride (31% ± 22%; P < 0.001) and placebo (34% ± 27%; P <
0.001), while u-NKCC2 and u-AQP2 did not change significantly during BFTZ (-7% ±
28%; P = 0.257 and 5% ± 16%; P = 0.261). U- ENaC? increased in all three groups
(P < 0.050). PRC, AngII and p-Aldo decreased to the same extent, while AVP
increased, but to a smaller degree during BFTZ (P = 0.048). cDBP decreased
significantly during BFTZ (P < 0.001), but not during amiloride or placebo. There
were no significant differences in body fluid volumes. CONCLUSION: After
hypertonic saline, u-NKCC2 and u-AQP2 increased during amiloride, but not during
BFTZ. Lower p-AVP during BFTZ potentially caused less stimulation of NKCC2 and
AQP2 and subsequent lower reabsorption of water and sodium.