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Renal Extraction of Para-Aminohippurate in Infants and Children

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Renal Extraction of Para-Aminohippurate in Infants and Children RENAL EXTRACTION OF PARA-AMINOHIPPURATE IN INFANTS AND CHILDREN Philip L. Calcagno, Mitchell I. Rubin J Clin Invest. 1963;42(10):1632-1639. https://doi.org/10.1172/JCI104848. Research Article Find the latest version: https://jci.me/104848/pdf journal of Clinical Investigation Vol. 42, No. 10, 1963 RENAL EXTRACTION OF PARA-AMINOHIPPURATE IN INFANTS AND CHILDREN * By PHILIP L. CALCAGNO t AND MITCHELL I. RUBIN (From the Statler Research Laboratories, Buffalo ChildreWs Hospital, and the Department of Pediatrics, School of Medicine, State University of New York, Buffalo, N. Y.) (Submitted for publication April 6, 1961; accepted July 3, 1963) Earlier publications questioned the reliability of studied with both diluents. All blood samples were col- measurements of renal plasma flow in young in- lected in heparinized tubes. Inulin and PAH were given to maintain arterial blood concentrations above 25 mg fants, since the extraction ratios for para-amino- per 100 ml for inulin and below 4 mg per 100 ml for hippurate (EPAH) used were those obtained in PAH. These values were not always obtained, but in adults (1-3). It was suggested that the use of the four infants given PAH in normal saline, the level these high values for EPAH to determine renal of renal arterial PAH was over 3.1 mg per 100 ml in plasma flow and filtration fraction might not be only one period of Patient 1. A no. 10 French catheter was placed in the bladder for valid and could account for the high filtration urine collections. The femoral artery and vein were fraction reported in infants under a year of age catheterized with Birds Eye catheters no. 5, 6, or 7. Un- (1-5). This high fraction was interpreted to in- der direct fluoroscopic supervision, the right renal vein dicate that the rate of glomerular filtration is was entered, and an attempt was made to enter the right greater in comparison to renal plasma flow than renal artery; if it was unsuccessful, arterial blood sam- ples were obtained from the aorta close to the renal that in adults. The present study was designed artery. Spot films were taken to demonstrate the lo- to measure EPAH in young infants in order to ar- cation of catheters before collections were made. Meas- rive at the true value for renal plasma flow and urements of glomerular filtration rate and effective renal calculated filtration fraction. plasma flow measurements were made in three infants and in one older child. Complete emptying of the bladder was obtained by instilling air, and blood was withdrawn METHODS simultaneously from the right renal vein and the right Fifteen children between 8 days and 10 years old were renal artery or aorta at the mid-point during the 20- studied; eight were under 3 months, and seven between minute urine collection periods. On several occasions, 5 months and 10 years old. Pertinent clinical and labora- duplicate blood samplings were obtained during a single tory data are listed in Tables I through IV. Forty-five urine collection period. At least three clearance periods minutes before testing, eight of the fifteen patients were were obtained during the study from each patient. For given a sedative; ' five were infants (no. 1 and 5-8) and comparison in the same patient of EPAR with normal sa- three were older children (no. 10, 11, and 15). Inulin2 and para-aminohippurate (PAH) were administered in TABLE I normal saline or 5% dextrose in water after base-line con- trol venous blood determinations were made. The diluent Pertinent clinical data of patients and the intervals from the mixing of PAH with the di- Patient luent to the end of the test are recorded in Tables II and no. Diagnosis Age Weight BSA III. Saline as the diluent for the PAH injection was used in four infants and in two children. Five per cent kg m2 dextrose in water was the diluent in four infants and in 1 Mongolism 8 days 2.47 0.188 seven children. Two infants and two children were 2 Cleft palate 10 days 2.90 0.209 3 Aortic stenosis 14 days 3.95 0.252 * 4 Mongolism 16 days 3.45 0.230 Aided by U. S. Public Health Service grants A-3257 5 Mongolism 1 mo 2.55 0.190 and HE-07927. 6 Mongolism 1 mo 2.75 0.186 t Present address: Georgetown University Medical 7 Mental retardation 2 mos 3.04 0.217 Center, 3800 Reservoir Road, N.W., Washington 7, D.C. 8 iv Septal defect 3 mos 4.42 0.256 I 9 Tetralogy of Fallot 5 mos 6.75 0.369 Chlorpromazine, 6.25 mg per ml; promethazine, 6.25 10 Mental retardation 8 mos 7.55 0.360 mg per ml; and meperidine hydrochloride, 25.00 mg per 11 Pulmonary stenosis 5 yrs 22.3 0.816 ml. The dose was 1 ml per 20 pounds of body weight, 12 iv Septal defect 5 yrs 17.5 0.725 up to a maximum of 2 ml. 13 iv Septal defect 6 yrs 18.2 0.750 14 Essential hypertension 8 yrs 45.5 1.263 2 Kindly supplied by the General Diagnostics Division, 15 Tetralogy of Fallot 10 yrs 27.9 0.948 Warner-Chilcott Laboratories, Morris Plains, N. J. 1632 RENAL EXTRACTION OF PARA-AMINOHIPPURATE IN INFANTS AND CHILDREN 1633 TABLE II Renal vein extraction (E) for inulin and para-aminohippurate (PAH) in infants Renal artery or aorta Rt. renal vein Patient Mixing no. Age Diluent* timet Inulin PAH Inulin PAH Ein EPAH min mg/100 ml % % 1 8 days Saline 480 23.9 1.82 19.5 0.63 22.6 65.4 34.8 1.40 29.1 0.42 16.5 70.0 50 ml blood + 200 ml normal saline 45.9 4.06 36.3 1.35 20.2 66.7 49.0 2.95 34.2 1.02 30.2 65.4 46.8 2.58 32.4 0.83 30.7 67.8 2 10 days Dextrose 240 157.9 5.70 101.2 1.87 36.0 67.2 163.9 5.20 108.4 1.94 34.2 62.7 25 ml blood, iv 177.1 5.94 131.5 2.23 25.4 62.5 3 14 days Dextrose 60 2.49 0.62 75.1 2.93 0.75 74.6 3.47 0.85 74.9 4 16 days Dextrose 210 79.5 6.00 65.5 5.03 17.6 16.2 77.4 6.15 66.4 4.42 14.2 28.0 72.0 5.70 59.6 2.40 17.2 58.0 5 1 I11o Saline 340 2.58 0.74 71.3 2.88 1.05 63.5 2.92 0.88 69.8 Dextrose 390 4.63 2.71 41.5 5.24 2.23 57.4 5.39 2.85 50.8 6 1 mo Saline 190 2.59 2.34 9.7 2.70 2.61 3.3 3.14 2.86 8.9 Dextrose 240 4.28 4.53 4.59 4.53 1.4 4.53 4.86 7 2 mos Dextrose 165 1.37 0.60 56.0 1.70 0.89 47.8 1.20 0.59 51.2 8 3 mos Saline 60 1.53 0.36 76.7 1.69 0.26 84.4 1.69 0.26 84.4 * Saline = normal saline; dextrose = 5% dextrose in water. t Time of mixing PAH to completion of test. line and with 5% dextrose in water, 15 minutes was al- fants varied from 0.5 to 1.0%o. The a-v differences for lowed for iv equilibration of the second fluid administra- PAH blank determinations were negligible. No cor- tion. In each case, the normal saline diluent was admin- rection was made for the delay in passage of the urine istered first. After the tests, the femoral artery was from the renal parenchyma to the catheter. Inulin and sutured with no. 60 silk, and the patients were given an PAH plasma E were calculated from the formula E= antibiotic for 48 hours. No serious untoward reactions (A - V) /A X 100, where A is arterial concentration were noted in any subject. and V is renal venous concentration, both in milligrams Inulin was determined by the method of Hubbard and per milliliter. Oxygen content was determined by a cu- Loomis (6), with the acid mixture for hydrolysis of inu- vette oximeter (9). lin as modified by Harrison (7). PAH was determined To ascertain that the renal vein was properly cathe- as described by Goldring and Chasis (8). Standard solu- terized, three criteria were used: 1) direct fluoroscopic tions of inulin and PAH were analyzed for construction visualization and spot films of the catheter in position, 2) of a calibration curve for each set of unknown solutions. the difference in arterial and renal venous oxygen satu- All determinations were made in duplicate. The a-v dif- ration of less than 10%}o, and 3) significant differences in ferences for inulin in blank determinations on three in- inulin concentrations between arterial and venous blood 1634 PHILIP L. CALCAGNO AND MITCHELL I. RUBIN TABLE III Renal vein extraction (E) for inulin and para-aminohippurate in children Renal artery or aorta Rt. renal vein Patient Mixing no. Age Diluent* timet Inulin PAH Inulin PAH Ein EPAH min mg/lOO ml % 9 5 mos Dextrose 135 3.52 0.27 92.4 4.96 0.48 90.4 4.27 0.50 88.4 10 8 mos Dextrose 210 44.4 1.73 35.3 0.21 20.6 87.9 44.7 1.85 36.4 0.26 18.7 86.0 45.2 1.85 37.5 0.24 17.0 87.0 11 5 yrs Saline 5 1.06 0.08 92.4 0.99 0.05 94.9 0.94 0.01 99.3 Dextrose 50 1.24 0.05 96.0 1.30 0.08 93.8 1.27 0.05 96.1 12 5S yrs Dextrose 75 1.61 0.14 91.2 1.67 0.14 91.6 2.03 0.15 92.6 13 6 yrs Dextrose 60 0.46 0.00 100.0 0.81 0.02 97.6 0.99 0.02 98.2 14 8 yrs Dextrose 240 29.2 0.84 20.5 0.20 29.8 76.2 24.0 0.72 18.0 0.15 25.0 79.2 24.0 0.71 18.0 25.0 22.8 0.63 14.3 0.07 37.3 88.9 15 10 yrs Saline 5 0.72 0.10 86.1 0.72 0.11 84.3 0.72 0.08 89.5 Dextrose 70 1.44 0.08 94.7 1.38 0.03 98.6 1.31 0.08 94.3 * Saline = normal saline; dextrose = 5% dextrose in water.
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