Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0235394 (wasting)
 8,040 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amiloride is a "potassium-sparing" diuretic agent of moderate natriuretic potency with site of action in postmacula densa segments of the distal nephron. In isolated segments of mammalian cortical distal nephron, amiloride diminishes sodium reabsorption and transtubular electrical PD and inhibits potassium secretion. We investigated the effects of long-term administration of a demonstrably maximal dose of amiloride (1.0 mg/kg b.i.d.) on plasma and urine acid-base and electrolyte composition in fixed steroid-replaced ADX dogs. Amiloride administration resulted in potassium retention and hyperkalemia and reduced net acid excretion and caused chronic hyperchloremic metabolic acidosis. The cumulative reduction in net acid excretion and severity of systemic acidosis were not significantly different in additional groups in which potassium retention was prevented by restriction of dietary potassium during amiloride administration or in which amiloride was administered to animals with pre-existing dietary potassium depletion. The response of urine pH and ammonium excretion, however, differed among groups. In the steady state of chronic acidosis, urine pH and ammonium concentration were lowest in the hyperkalemic group and highest in the hypokalemic group, and among the three groups pH and ammonium were positively correlated (r = 0.67, p less than 0.001). Ammonium concentration varied inversely with plasma potassium concentration. Net acid excretion rates returned to control levels during the steady state of chronic amiloride-induced acidosis in the three groups. During continued amiloride administration, sustained correction of acidosis by long-term oral administration of sodium bicarbonate did not result in negative values of net acid excretion; that is, amiloride did not cause net wasting of base at normal plasma bicarbonate concentration. The results of these studies suggest that chronic amiloride administration results in a sustained impairment of renal hydrogen ion secretion restricted to the distal nephron and not dependent on alterations in potassium balance. Differences in potassium balance (positive or negative) appeared to influence only the availability of ammonia for diffusion into urine and steady-state urine pH, but not the steady-state net rate of renal hydrogen ion secretion during amiloride. These studies identify an experimental model of chronic distal renal tubular acidosis in which external hydrogen ion balance is re-established during chronic acidosis even when the availability of ammonia for excretion is decreased.
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PMID:Pathophysiology of chronic renal tubular acidosis induced by administration of amiloride. 736 13

Isolated hypoaldosteronism is a rare cause of salt wasting in infancy and may be life-threatening, especially in the newborn infant. In a 3wk-old-boy with hyponatremia and hyperkalemia a GC-MS steroid profile on a spot urinary sample showed no 18-oxygenated steroid metabolites indicative for aldosterone synthase deficiency type I. Sequence analysis of the CYP11B2 gene revealed that the patient was homozygous for a novel missense mutation (L451F) caused by a T to C transition at position c.1351 in exon 8, whereas each non-symptomatic parent possessed only one mutated allele. The mutant cDNA was transiently expressed in a human cell line, HCT116 p53(-/-), and activity of the expressed protein optimized by co-expression of different adrenodoxin species, showing complete aldosterone deficiency with 11-deoxycorticosterone or corticosterone as substrates. The L451F mutation is the first mutation found located immediately adjacent to the highly conserved heme-binding C450 of the cytochrome P450. Computer modeling shows that replacement of leucine by phenylalanine leads to a steric effect in the immediate vicinity of the heme thereby preventing the activity of CYP11B2. Thus, by combining highly sensitive hormone detection in a spot urine sample with expression of the mutated cDNA in cell culture the phenotype of the patient can be correlated with a particular molecular defect.
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PMID:Aldosterone synthase deficiency caused by a homozygous L451F mutation in the CYP11B2 gene. 1817 1