RESUMO
BACKGROUND: Diabetic kidney disease (DKD) is a severe complication of diabetes mellitus (DM). It has been proposed that modifications in the function of proximal tubule epithelial cells (PTECs) precede glomerular damage during the onset of DKD. This study aimed to identify modifications in renal sodium handling in the early stage of DM and its molecular mechanism. METHODS: Streptozotocin (STZ)-induced diabetic BALB/c mice (STZ group) and LLC-PK1 cells, a model of PTECs, were used. All parameters were assessed in the 4th week after an initial injection of STZ. RESULTS: Early stage of DKD was characterized by hyperfiltration and PTEC dysfunction. STZ group exhibited increased urinary sodium excretion due to impairment of tubular sodium reabsorption. This was correlated to a decrease in cortical (Na++K+)ATPase (NKA) α1 subunit expression and enzyme activity and an increase in O-GlcNAcylation. RNAseq analysis of patients with DKD revealed an increase in expression of the glutamine-fructose aminotransferase (GFAT) gene, a rate-limiting step of hexosamine biosynthetic pathway, and a decrease in NKA expression. Incubation of LLC-PK1 cells with 10 µM thiamet G, an inhibitor of O-GlcNAcase, reduced the expression and activity of NKA and increased O-GlcNAcylation. Furthermore, 6-diazo-5-oxo-L-norleucine (DON), a GFAT inhibitor, or dapagliflozin, an SGLT2 inhibitor, avoided the inhibitory effect of HG on expression and activity of NKA associated with the decrease in O-GlcNAcylation. CONCLUSION: Our results show that the impairment of tubular sodium reabsorption, in the early stage of DM, is due to SGLT2-mediated HG influx in PTECs, increase in O-GlcNAcylation and reduction in NKA expression and activity.
Assuntos
Diabetes Mellitus , Nefropatias Diabéticas , Camundongos , Suínos , Animais , Humanos , Túbulos Renais Proximais/metabolismo , Rim/metabolismo , Nefropatias Diabéticas/metabolismo , Sódio/metabolismo , Adenosina Trifosfatases/metabolismo , Diabetes Mellitus/metabolismoRESUMO
Heart failure (HF) is the common final pathway of several conditions and is characterized by hyperactivation of numerous neurohumoral pathways. Cardiorenal interaction plays an essential role in the progression of the disease, and the use of diuretics is a cornerstone in the treatment of hypervolemic patients, especially in acute decompensated HF (ADHF). The management of congestion is complex and, to avoid misinterpretations and errors, one must understand the interface between the heart and the kidneys in ADHF. Congestion itself may impair renal function and must be treated aggressively. Transitory elevations in serum creatinine during decongestion is not associated with worse outcomes and diuretics should be maintained in patients with clear hypervolemia. Monitoring urinary sodium after diuretic administration seems to improve the response to diuretics as it allows for adjustments in doses and a personalized approach. Adequate assessment of volemia and the introduction and titration of guideline-directed medical therapy are mandatory before discharge. An early visit after discharge is highly recommended, to assess for residual congestion and thus avoid readmissions.
RESUMO
BACKGROUND: Restriction of sodium intake is routinely recommended for patients with chronic kidney disease (CKD). Whether or not sodium intake is associated with the progression of CKD and mortality remains uncertain. We evaluated the association between urinary sodium excretion (as a surrogate for sodium intake) with the occurrence of renal failure and mortality in patients with non-dialytic CKD. METHODS: We conducted a retrospective study of patients followed at a CKD clinic care hospital from October 2006 to March 2017. Adult patients with non-dialytic CKD were included. Using a time-to-event analysis, we examined the association of urinary sodium excretion as a categorical variable (categorized as quintiles: 1st quintile: 0.54-2.51 g; 2nd quintile: 2.52-3.11 g, 3rd quintile: 3.12-3.97 g, 4th quintile: 3.98-5.24 g and 5th quintile: 5.26-13.80 g) and the outcomes of interest. The primary outcome was defined as progression to end-stage renal disease requiring any type of renal replacement therapy. The secondary outcome was mortality. RESULTS: Two hundred five patients were included in the study (mean follow up of 2.6 years) with a mean eGFR of 26 (19-41) ml/min/1.73m2. 37 patients (18%) required renal replacement therapy and 52 (25,3%) died. There was association between urinary sodium excretion and need for renal replacement therapy (adjusted HR 0.245; 95%CI 0.660-0.912). There was no association between urinary sodium excretion and mortality in adjusted models. CONCLUSION: Moderate sodium intake was associated with a lower risk of renal failure.
Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Insuficiência Renal , Adulto , Progressão da Doença , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Insuficiência Renal/complicações , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , SódioRESUMO
Background: Excess dietary salt consumption is a major contributor to hypertension and cardiovascular disease. Public education programs on the dangers of high salt intake, and population level interventions to reduce the salt content in foods are possible strategies to address this problem. In Jamaica, there are limited data on the levels of salt consumption and the population's knowledge and practices with regards to salt consumption. This study therefore aims to obtain baseline data on salt consumption, salt content in foods sold in restaurants, and evaluate knowledge, attitudes, and practices of Jamaicans regarding salt consumption. Methods: The study is divided into four components. Component 1 will be a secondary analysis of data on urinary sodium from spot urine samples collected as part of a national survey, the Jamaica Health and Lifestyle Survey 2016-2017. Component 2 will be a survey of chain and non-chain restaurants in Jamaica, to estimate the sodium content of foods sold in restaurants. Component 3 is another national survey, this time on a sample 1,200 individuals to obtain data on knowledge, attitudes and practices regarding salt consumption and estimation of urinary sodium excretion. Component 4 is a validation study to assess the level of agreement between spot urine sodium estimates and 24-hour urinary sodium from 120 individuals from Component 3. Discussion: This study will provide important baseline data on salt consumption in Jamaica and will fulfil the first components of the World Health Organization SHAKE Technical Package for Salt Reduction. The findings will serve as a guide to Jamaica's Ministry of Health and Wellness in the development of a national salt reduction program. Findings will also inform interventions to promote individual and population level sodium reduction strategies as the country seeks to achieve the national target of a 30% reduction in salt consumption by 2025.
Assuntos
População do Caribe , Conhecimentos, Atitudes e Prática em Saúde , Cloreto de Sódio na Dieta , Sódio , Humanos , Jamaica , Restaurantes , Sódio/urina , Cloreto de Sódio na Dieta/administração & dosagemRESUMO
OBJECTIVES: To evaluate urinary iodine concentration (UIC) in civil servants aged 35-74 years of the Brazilian Study of Adults Health (ELSA-Brasil) to analyze its relationship with sociodemographic, clinical risk factors, lifestyle, urinary Na and thyroid status. DESIGN: Cross-sectional study in six Brazilian cities. METHODS: This analysis included 792 participants with information about urinary iodine concentration (UIC). Thyroid status was defined by serum levels of TSH/FT4 and the current use of antithyroid drugs for treatment of overt hyperthyroidism or levothyroxine to treat overt hypothyroidism. The determination of UIC was carried out with an inductively coupled plasma mass spectrometer (ICP-MS) and was expressed as median with Interquartile Range (IQR). RESULTS: In 792 participants, thereof 52% women, mean age was 51.9 (9.0) years. The median UIC was 219 (IQR, 166-291) for all persons studied, thereof 211 (IQR, 157-276) for women and 231 (IQR, 178-304) for men. According to the WHO classification, for all persons studied, 60% had more than adequate iodine-supply (UIC ≥200⯵g/L), 37% were adequately supplied (UIC 100-199⯵g/L) and <3% had a deficient iodine status (<100⯵g/L). In the 35-44-year age strata, which includes women of childbearing age, 23.2% of women presented less than 150⯵g/L of UIC. No differences in UIC were detected according to thyroid status. (Pâ¯=â¯0.39) The correlation between Ur-Na and UIC showed a Spearman coefficient of 0.52 (Pâ¯<â¯0.0001) and it was also found an association of Ur-Na with UIC: Beta of 1.76 (95% Confidence Interval (95% CI): 1.01 to 2.51. The urinary Na concentration showed a synergy with the UIC, that means medians of 57, 72, 107 and 141â¯mmol Na/L urine (Pâ¯<â¯0.001) in the groups with the four UIC classes according to the WHO grading mentioned above. The very low Na content in the persons exhibiting <100⯵g/L UIC seems to reflect also a higher urine volume due to the frequent use of diuretics. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. CONCLUSIONS: Euthyroid persons were dominating by more than four fifths and no significant association was found between UIC and thyroid status. Although most of the persons studied present more than adequate iodine intake it was observed that nearly a quarter of women in childbearing age are iodine deficient.
Assuntos
Iodo , Glândula Tireoide , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Sódio , Cloreto de Sódio na Dieta , Adulto JovemRESUMO
INTRODUCTION: Bariatric surgery has been shown to be effective in reducing weight and has benefits, such as lowering blood pressure. An increase in urinary sodium excretion has been suggested as a possible mechanism. This study explored changes in sodium excretion and their correlation with blood pressure after Roux-en-Y gastric bypass. MATERIALS AND METHODS: This study was conducted on 28 obese participants with body mass index (BMI) of 44.54 ± 7.81 kg/m2 who underwent gastric bypass. Before surgery and at the third and sixth months after gastric bypass, blood pressure, urinary sodium concentration, 24-hour (24-h) urinary sodium excretion, and fractional excretion of sodium were evaluated. In addition, serum sodium and potassium levels were determined. Nonparametric tests were used to analyze the data. RESULTS: Blood pressure decreased after surgery and remained at low levels over the 3- and 6-month periods. The urinary sodium concentration increased at 3 months after surgery; however, the 24-h urinary sodium excretion and urine volume decreased. Interestingly, although some associations between variables were observed, significant correlations between the 24-h urinary sodium excretion and the systolic, diastolic, and mean blood pressures were found. In addition, the urine volume was higher in the sixth month than in the third month following surgery. CONCLUSIONS: In the months immediately following surgery, a low-salt and low-volume diet favors decreases in urine volume and 24-h urinary sodium excretion. In addition, in the sixth month after surgery, an association between blood pressure and 24-h urinary sodium excretion was observed.
Assuntos
Pressão Sanguínea/fisiologia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Eliminação Renal/fisiologia , Sódio/metabolismo , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Derivação Gástrica/métodos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/urina , Período Pós-Operatório , Potássio/sangue , Sódio/sangue , Sódio/urina , Fatores de Tempo , Redução de Peso/fisiologiaRESUMO
Mexico is considered as a nutritional transition country with a high prevalence of overweight and obesity, and recent studies have reported a high iodine intake in children. Both high iodine intake and obesity have been associated with thyroid dysfunction. Our aim was to assess iodine and salt intake and thyroid function in Mexican schoolchildren with normal weight and obesity. A cross-sectional study was performed during 2012-2013 in schoolchildren from Queretaro, Mexico. Six hundred seventy-eight schoolchildren were evaluated to obtain nutrition status, urinary iodine concentration (UIC) and thyroid volume (TVol). The prevalence of overweight and obesity was 47.3 %, the median UIC was 428 µg/L and TVol was normal in all schoolchildren; however, obese girls had a higher TVol than normal weight at the age of 8, 10 and 12 years. A subsample of schoolchildren was divided in 6-8 and 9-12-year-old groups, in order to compare thyroid function (thyrotropin, free T4, and anti-thyroid antibodies); iodine and salt intake were estimated with 24-h urinary samples. No differences in thyroid function were observed in both age groups. In the 6-8-year-old group, obese schoolchildren had higher iodine intake than normal-weight children (415.5 vs. 269.1 µg/day, p < 0.05), but no differences in salt intake. In contrast, in the 9-12-year-old group, obese schoolchildren had higher salt intake than normal-weight children (6.2 vs. 3.8 g/day, p < 0.05), but no differences in iodine intake. Dietary patterns could explain the differences between both age groups. Further studies are needed to identify the main sources of iodine intake in Mexican populations.
Assuntos
Iodo/administração & dosagem , Obesidade/metabolismo , Cloreto de Sódio na Dieta/administração & dosagem , Glândula Tireoide/metabolismo , Criança , Estudos Transversais , Feminino , Humanos , Iodo/urina , Masculino , México , Obesidade/urina , Cloreto de Sódio na Dieta/urina , Testes de Função TireóideaRESUMO
El objetivo de este estudio fue evaluar la relación entre adiposidad abdominal con insulino-resistencia, hipertensión arterial y excreción urinaria de sodio en adolescentes obesos. Se realizó un estudio transversal descriptivo que incluyó 107 adolescentes obesos, entre 10 y 14 años, sin restricción dietaria, provenientes del Hospital de Pediatría-Posadas, Misiones, durante los años 2011-2012. Se definió obesidad abdominal según: perímetro de cintura ≥p90, hipertensión arterial: presión arterial sistólica y/o diastólica ≥p95 y prehipertensión ≥p90 y
The aim of this study was to assess abdominal adiposity relationship with insulin resistance, high blood pressure and urinary sodium excretion in an obese adolescent population. A descriptive cross sectional study that included 107 obese teenagers from 10 to 14 years of age without any dietary restriction was performed during 2011 and 2012 at the Pediatric Hospital, in Posadas, Misiones. Abdominal obesity was defined as: waist perimeter ≥p90, hypertension: systolic and/or diastolic pressure ≥p95 and prehypertension ≥p90 and
O objetivo deste estudo foi avaliar a relaþÒo de adiposidade abdominal com insulino-resistÛncia, hipertensÒo arterial e excreþÒo urinária de sódio em adolescentes obesos. Foi realizado um estudo transversal descritivo que incluiu 107 adolescentes obesos, entre 10 e 14 anos, sem restriþÒo na dieta, provenientes do Hospital de Pediatría Posadas, Misiones, durante os anos 2011-2012. Definiu-se obesidade abdominal conforme o perímetro de cintura ≥p90, hipertensÒo arterial: pressÒo arterial sistólica e/ou diastólica ≥p95 e pré-hipertensÒo ≥p90 e
RESUMO
El objetivo de este estudio fue evaluar la relación entre adiposidad abdominal con insulino-resistencia, hipertensión arterial y excreción urinaria de sodio en adolescentes obesos. Se realizó un estudio transversal descriptivo que incluyó 107 adolescentes obesos, entre 10 y 14 años, sin restricción dietaria, provenientes del Hospital de Pediatría-Posadas, Misiones, durante los años 2011-2012. Se definió obesidad abdominal según: perímetro de cintura ≥p90, hipertensión arterial: presión arterial sistólica y/o diastólica ≥p95 y prehipertensión ≥p90 y
The aim of this study was to assess abdominal adiposity relationship with insulin resistance, high blood pressure and urinary sodium excretion in an obese adolescent population. A descriptive cross sectional study that included 107 obese teenagers from 10 to 14 years of age without any dietary restriction was performed during 2011 and 2012 at the Pediatric Hospital, in Posadas, Misiones. Abdominal obesity was defined as: waist perimeter ≥p90, hypertension: systolic and/or diastolic pressure ≥p95 and prehypertension ≥p90 and
O objetivo deste estudo foi avaliar a relação de adiposidade abdominal com insulino-resistência, hipertensão arterial e excreção urinária de sódio em adolescentes obesos. Foi realizado um estudo transversal descritivo que incluiu 107 adolescentes obesos, entre 10 e 14 anos, sem restrição na dieta, provenientes do Hospital de Pediatría Posadas, Misiones, durante os anos 2011-2012. Definiu-se obesidade abdominal conforme o perímetro de cintura ≥p90, hipertensão arterial: pressão arterial sistólica e/ou diastólica ≥p95 e pré-hipertensão ≥p90 e Assuntos
Humanos
, Masculino
, Feminino
, Criança
, Adolescente
, Hipertensão
, Resistência à Insulina
, Obesidade Abdominal/sangue
, Obesidade Abdominal/urina
, Modalidades de Secreções e Excreções
, Obesidade
, Eliminação Renal
RESUMO
Introducción: la medición de la excreción urinaria de sodio es importante en pacientes con litiasis urinaria, pues su excreción elevada predispone a hipercalciuria, el trastorno metabólico urinario más frecuente. Objetivo: determinar la ingestión (igual a excreción) de sodio e identificar su posible relación con variables demográficas y nutricionales, en pacientes con litiasis urinaria. Métodos: se desarrolló un estudio analítico, transversal, de los pacientes con litiasis urinaria que se hicieron estudio metabólico renal en el Instituto de Nefrología, entre enero 2011 y diciembre 2012. Se excluyeron los pacientes con factores que modifican la excreción de sodio. Las determinaciones de creatinina fueron realizadas por el método cinético de Jaffé, con espectrofotómetro Jenway®; las mediciones del sodio urinario, con analizador electrolítico marca Roche®. La información fue procesada de forma automatizada (SPSS versión 15.0). En cada categoría de las variables fueron calculadas media y desviación estándar de la excreción de sodio (mEq/d). Las comparaciones de los promedios se realizaron mediante la prueba t o mediante ANOVA. Resultados: de 1 985 pacientes estudiados, 1 363 fueron del sexo masculino (68,7 por ciento) y 622, del femenino (31,3 por ciento). La excreción urinaria media de sodio fue 235,29 mEq/d, globalmente, y resultó mayor en los hombres (252,69 mEq/d), al ser comparada con la de las mujeres (197,14 mEq/d) (p= 0,00). También se encontraron diferencias al comparar la excreción de sodio entre las categorías de valoración nutricional (p= 0,00) y de excreción de creatinina (p= 0,0). Conclusiones: la excreción urinaria de sodio es elevada en pacientes urolitiásicos, mayor en los hombres y en los sujetos con sobrepeso y obesidad...
Introduction: measurement of urinary sodium excretion is important in patients with urolithiasis, for a high level of excretion leads to hypercalciuria, the most common urinary metabolic disorder. Objective: to determine sodium intake (equal to excretion) and identify its possible relationship to demographic and nutritional variables in patients with urinary lithiasis. Methods: an analytical cross-sectional study was conducted in patientes with urinary lithiasis undergoing metabolic renal study at the Institute of Nephrology from January 2011 to December 2012. Patients with factors modifying sodium excretion were excluded. Creatinine determinations were made with Jaffé's kinetic method using a Jenway spectrophotometer. Urinary sodium was measured with a Roche electrolytic analyzer. Data was processed with the statistical software SPSS version 15.0. Variables for each category were estimated as mean and standard deviation of sodium excretion (mEq/d). Comparisons of averages were made with the t test or ANOVA. Results: of the 1 985 patients studied, 1 363 were male (68.7 percent) and 622 were female (31.3 percent). Global mean sodium urinary excretion was 235.29 mEq/d, greater in men (252.69 mEq/d) than in women (197.14 mEq/d) (p= 0.00). Differences were also found when sodium excretion was compared by nutritional assessment (p= 0.00) and creatinine excretion (p= 0.0). Conclusions: urinary sodium excretion is high in patients with urolithiasis. Values are higher in men, and in overweight and obese individuals...