Vittorio E. Andreucci

Muzolimine: a new high-ceiling diuretic suitable for patients with advanced renal disease.

Muzolimine was administered by mouth to 24 patients with creatinine clearances ranging from 4 to 28 ml/min to treat oedema or hypertension, or both. In four of these 24 patients muzolimine was given after intravenous high-dose frusemide had been unsuccessful. Muzolimine significantly increased urine volume and excretions of sodium, chloride, and potassium ions. Its diuretic efficacy was further shown by a mean reduction in body-weight of 8% and by the disappearance of oedema in all affected patients, even those refractory to intravenous frusemide. No rebound phenomenon was observed after the drug was stopped. Mean blood pressure was reduced in all hypertensive patients. Blood pressure was restored to normal in five out of seven patients treated with muzolimine alone and 10 out of 11 in whom muzolimine had been added to previously unsatisfactory antihypertensive treatment. Muzolimine was well tolerated by all patients. Muzolimine appears to be the diuretic of choice when treating patients with advanced renal disease.

Treatment of Chronic Hypertension in Pregnancy

There is still controversy as to whether mild hypertension antedating pregnancy has to be treated in pregnant women. Some authors are against treatment since the possible benefit of normalizing blood pressure is not relevant to the brief span of gestation [1], Others emphasize that treatment of chronic hypertension in pregnancy (CHP) reduces the occurrence of midtrimester abortions [2].

Reliability of radioactive inulin as a marker of glomerular filtration rate in the rat

SummaryClearance experiments were carried out in rats for evaluating the reliability of Inulin-Methoxy-H3 as marker for GFR determination. When H3 Inulin clearance was compared with C14 Polyethylen Glycol (PEG) 1000 clearance, a linear relationship was observed (y=0.021+0.867x;r=0.98).H3 Inulin clearance/C14 PEG clearance ratio was 0.88±0.09 (S.D.), i.e. a value no different from those reported in literature for unlabeled Inulin, C14 Inulin and Polyfructosan S. Several types of scintillation solution were tested to evaluate the stability with time of count rate of radioactive Inulin. A perfect reproducibility with time was observed in the clearance values in the kidney as a whole (GFR) and in single nephrons (SNGFR) with the following scintillators: Triton X 100-Toluene-PPO, Aquasol and Instagel. Useful suggestions on the way of using labeled Inulin are given.

Renal Radiology and Acute Renal Failure

Patients with ARF require early diagnosis of the type of ARF and of the exclusion of surgically correctable causes such as renal artery occlusion or urinary tract obstruction.

Acute Obstructive Renal Failure (Postrenal Failure)

Obstruction has been recognized since antiquity as a common cause of urinary disorder [1]. It is, indeed, one of the most frequent causes of chronic renal failure [2].

Renal Hemodynamics in Pregnancy

In normal pregnant women, plasma volume begins to rise after six weeks of amenorrhea [1] and attains the maximum increment toward the end of the second trimester. This increase is sustained to term [2]. The maximum amount by which plasma volume increases is extremely variable, ranging from 0.6 to 2.0 liters in different women, and is chiefly related to the size of the product of conception [1]. In pregnancy, the red cell mass also increases, but to a lesser extent than plasma volume, leading to a fall in hematocrit [3]. The increase in blood volume is associated with a rise in cardiac output (CO) [4]. Opinions differ as to whether CO is increased throughout gestation [5] or declines in late pregnancy [6]. Recently, serial measurements of CO in normal pregnant women have been performed by noninvasive technique [7]. These studies have confirmed a 20% increase in CO at week 15. CO rises further to a peak increment of 40% at weeks 25–28 of gestation, and then declines to near postpartum levels in the final weeks. In early pregnancy, the increase in CO is mainly due to an increased stroke volume (SV). As pregnancy advances, the rise in SV diminishes and increased heart rate becomes significantly contributory in maintaining the elevated CO. Echocardiographic studies have shown that the high-output hemodynamic condition in pregnancy is associated with a significant increase in left ventricular mass [8].