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  1. Article ; Online: Vasopressin Antagonists.

    Berl, Tomas

    The New England journal of medicine

    2015  Volume 373, Issue 10, Page(s) 981

    MeSH term(s) Antidiuretic Hormone Receptor Antagonists/pharmacology ; Antidiuretic Hormone Receptor Antagonists/therapeutic use ; Humans ; Hyponatremia/drug therapy ; Vasopressins/physiology
    Chemical Substances Antidiuretic Hormone Receptor Antagonists ; Vasopressins (11000-17-2)
    Language English
    Publishing date 2015-09-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc1508385
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Vasopressin antagonists.

    Berl, Tomas

    The New England journal of medicine

    2015  Volume 372, Issue 23, Page(s) 2207–2216

    MeSH term(s) Antidiuretic Hormone Receptor Antagonists/adverse effects ; Antidiuretic Hormone Receptor Antagonists/pharmacokinetics ; Antidiuretic Hormone Receptor Antagonists/pharmacology ; Antidiuretic Hormone Receptor Antagonists/therapeutic use ; History, 19th Century ; History, 20th Century ; History, 21st Century ; Humans ; Hyponatremia/blood ; Hyponatremia/drug therapy ; Practice Guidelines as Topic ; Sodium/blood ; Vasopressins/history ; Vasopressins/physiology
    Chemical Substances Antidiuretic Hormone Receptor Antagonists ; Vasopressins (11000-17-2) ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2015-06-04
    Publishing country United States
    Document type Historical Article ; Journal Article ; Review
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMra1403672
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Physiology and Pathophysiology of Water Homeostasis.

    Rondon-Berrios, Helbert / Berl, Tomas

    Frontiers of hormone research

    2019  Volume 52, Page(s) 8–23

    Abstract: In the evolutionary process, the successful adaptation of living organisms initially to an aqueous and thereafter to an arid terrestrial environment posed radically different challenges to the maintenance of water balance. Whereas the former required ... ...

    Abstract In the evolutionary process, the successful adaptation of living organisms initially to an aqueous and thereafter to an arid terrestrial environment posed radically different challenges to the maintenance of water balance. Whereas the former required defense against water excess, the latter called for water conservation. To meet such challenges, the mammalian nephron evolved mechanisms for increasing both water excretion by diluting and water conservation by concentrating the urine. This chapter reviews the process whereby the osmosensors control thirst and the secretion of the antidiuretic hormone (vasopressin) to allow for either urinary dilution or concentration and thereby delicately maintain tonicity of body fluids within a very narrow range. Central to this process is the now well-defined cellular pathway whereby vasopressin renders the collecting duct, water permeable. Disorders of vasopressin secretion and action result in disturbances of body fluids tonicity, which are clinically recognized as abnormalities in reduced plasma sodium concentration or hyponatremia.
    MeSH term(s) Animals ; Body Water/metabolism ; Homeostasis/physiology ; Humans ; Hyponatremia/metabolism ; Thirst/physiology ; Urine/physiology ; Vasopressins/metabolism
    Chemical Substances Vasopressins (11000-17-2)
    Language English
    Publishing date 2019-01-15
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 1662-3762 ; 0301-3073
    ISSN (online) 1662-3762
    ISSN 0301-3073
    DOI 10.1159/000493233
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: An elderly patient with chronic hyponatremia.

    Berl, Tomas

    Clinical journal of the American Society of Nephrology : CJASN

    2013  Volume 8, Issue 3, Page(s) 469–475

    Abstract: Hyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this ... ...

    Abstract Hyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this Attending Rounds, an illustrative patient with hyponatremia is presented. The reasons for the increased incidence and prevalence of hyponatremia in the elderly are discussed, with emphasis on the effects of aging on urinary dilution, the frequently multifactorial nature of hyponatremia in this population, and the absence of a definite cause for inappropriate and persistent vasopressin release in many such patients. The rationale for treating the hyponatremia, even when apparently asymptomatic, is discussed, with attention to cognitive function, gait, and bone structure disturbances that increase the risk for fractures. The various available treatment approaches, including water restriction, demeclocycline, loop diuretics with NaCl supplementation, urea, and vasopressin antagonists are summarized, with emphasis on the efficacy and limitations of each of these therapies.
    MeSH term(s) Age Factors ; Aged ; Antidiuretic Hormone Receptor Antagonists ; Biomarkers/blood ; Chronic Disease ; Demeclocycline/therapeutic use ; Drinking ; Female ; Hormone Antagonists/therapeutic use ; Humans ; Hyponatremia/blood ; Hyponatremia/diagnosis ; Hyponatremia/etiology ; Hyponatremia/physiopathology ; Hyponatremia/therapy ; Predictive Value of Tests ; Risk Factors ; Sodium/blood ; Sodium Chloride/therapeutic use ; Sodium Potassium Chloride Symporter Inhibitors/therapeutic use ; Treatment Outcome ; Urea/therapeutic use ; Urination ; Water-Electrolyte Balance
    Chemical Substances Antidiuretic Hormone Receptor Antagonists ; Biomarkers ; Hormone Antagonists ; Sodium Potassium Chloride Symporter Inhibitors ; Sodium Chloride (451W47IQ8X) ; Demeclocycline (5R5W9ICI6O) ; Urea (8W8T17847W) ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2013-03
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.03100312
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Book: Festschrift honoring Dr. Robert W. Schrier

    Schrier, Robert W. / Berl, Tomas

    (Kidney international : Supplement ; 61)

    1997  

    Author's details guest ed.: Tomas Berl
    Series title Kidney international : Supplement ; 61
    Kidney international
    Kidney international ; Supplement
    Collection Kidney international
    Kidney international ; Supplement
    Keywords Nephrology / essays
    Language English
    Size S-92 S. : Ill., graph. Darst.
    Publisher Blackwell Science
    Publishing place Cambridge, Mass
    Publishing country United States
    Document type Book
    HBZ-ID HT007815617
    Database Catalogue ZB MED Medicine, Health

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    Shelf markLoan statusLocation
    Zs A 797 -Suppl.61- not available for loan Zeitschriften-Lesesaal

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  6. Article: Vasopressin Receptor Antagonists in Hyponatremia: Uses and Misuses.

    Rondon-Berrios, Helbert / Berl, Tomas

    Frontiers in medicine

    2017  Volume 4, Page(s) 141

    Abstract: Decreases in the concentration of sodium in plasma constitute hyponatremia, the commonest electrolyte disorder in clinical medicine. It is now well established that its presence conveys an increased mortality risk even when the decrement is mild. In ... ...

    Abstract Decreases in the concentration of sodium in plasma constitute hyponatremia, the commonest electrolyte disorder in clinical medicine. It is now well established that its presence conveys an increased mortality risk even when the decrement is mild. In addition, recent evidence suggests that chronic and apparently asymptomatic hyponatremia is associated with increased morbidity including neurocognitive deficits and bone fractures. Furthermore, hyponatremia is associated with higher health care-related expenses. Consequently, exploring new therapeutic strategies that increase plasma sodium in a safe and effective manner is of paramount importance. In this regard, there are scant data to support the use of traditional management strategies for hyponatremia (fluid restriction, salt tablets, loop diuretics, and normal saline). Furthermore, data from a large hyponatremia registry reveal the limited efficacy of these therapies. More recently vasopressin receptor antagonists provide a promising treatment for hyponatremia by targeting its most common mechanism, namely, increased vasopressin activity. However, uncertainty still lingers as to the optimal indications for the use of vasopressin receptor antagonists in hyponatremia and a few reports have described complications resulting from their misuse. This review summarizes the appropriate and inappropriate uses of vasopressin receptor antagonists in the treatment of hyponatremia.
    Language English
    Publishing date 2017-08-21
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2017.00141
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: How do kidney cells adapt to survive in hypertonic inner medulla?

    Berl, Tomas

    Transactions of the American Clinical and Climatological Association

    2009  Volume 120, Page(s) 389–401

    Abstract: The hypertonic inner medulla poses challenges to the cells that inhabit this area of the nephron. We employed discovery tools including proteomics and genomics to identify proteins that subserve the adaptive response. The gamma subunit of the Na/K-ATPase ...

    Abstract The hypertonic inner medulla poses challenges to the cells that inhabit this area of the nephron. We employed discovery tools including proteomics and genomics to identify proteins that subserve the adaptive response. The gamma subunit of the Na/K-ATPase is critical to the survival of cells in hypertonic conditions, as silencing it increases osmosensitvity, and overexpression increases osmotolerance. The inner medullary collecting duct (IMCD) has high transepithelial resistance (TER). Proteins responsible for tight junction integrity are upregulated in hypertonic states. Multi PDZ protein 1 (MUPP1), a PDZ scaffolding protein, targets Claudin 4 to the tight junction. The silencing of either of these proteins decreases TER and renders the epithelium leaky. The accumulation of inert osmolytes is integral to the adaptive response. The genes involved are regulated by the transcription factor Tonicity Enhancer Binding Protein. An osmoregulated nuclear protein Nup88 is critical to the retention of this transcription factor in the nucleus and to the generation of the osmolytes. In summary, IMCD cells bring forth a coordinated response to hypertoncity that is necessary for cell survival and function of these cells in anisotonic conditions.
    MeSH term(s) Adaptation, Physiological ; Animals ; Claudin-4 ; Energy Metabolism ; Humans ; Kidney Medulla/cytology ; Kidney Medulla/physiology ; Membrane Proteins/physiology ; Nuclear Pore Complex Proteins/physiology ; Protein Subunits ; Signal Transduction ; Sodium-Potassium-Exchanging ATPase/chemistry ; Sodium-Potassium-Exchanging ATPase/metabolism ; Water-Electrolyte Balance
    Chemical Substances CLDN4 protein, human ; Claudin-4 ; Membrane Proteins ; Nuclear Pore Complex Proteins ; Protein Subunits ; Sodium-Potassium-Exchanging ATPase (EC 7.2.2.13)
    Language English
    Publishing date 2009-09-18
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 603823-2
    ISSN 0065-7778
    ISSN 0065-7778
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Review: renal protection by inhibition of the renin-angiotensin-aldosterone system.

    Berl, Tomas

    Journal of the renin-angiotensin-aldosterone system : JRAAS

    2009  Volume 10, Issue 1, Page(s) 1–8

    Abstract: Unlabelled: Renin-angiotensin-aldosterone system (RAAS) inhibition exerts a renoprotective effect independent of blood pressure reduction. Many studies using an end-point of proteinuria compared the effects of angiotensin-converting enzyme inhibitor ( ... ...

    Abstract Unlabelled: Renin-angiotensin-aldosterone system (RAAS) inhibition exerts a renoprotective effect independent of blood pressure reduction. Many studies using an end-point of proteinuria compared the effects of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) monotherapy with combination ACE-I/ARB therapy. Despite methodological limitations, most studies suggest that combination therapy provides a greater antiproteinuric effect than monotherapy, perhaps because of more prolonged and complete RAAS inhibition. COOPERATE and ONTARGET used more robust end-points to study renoprotective effects. In COOPERATE, combination therapy resulted in significantly longer times to doubling serum creatinine or developing end-stage renal disease than trandolapril or losartan monotherapy. However, a secondary ONTARGET finding was that combination therapy significantly increased the risk for renal dysfunction compared with ramipril or telmisartan alone. Eventually, the VA NEPHRON-D trial should provide definitive data relating to patients with diabetic nephropathy.
    Results: of AVOID suggest the renoprotective benefits of combination therapy extend to the direct renin inhibitors (DRI). In AVOID, combination therapy with aliskiren, a DRI, and losartan resulted in 20% greater protein excretion decrement than losartan monotherapy. Future trials should examine higher RAAS inhibitor doses, facilitate differentiation of renoprotective and antihypertensive effects of RAAS blockade, and use end-points that robustly demonstrate renoprotective effects.
    MeSH term(s) Angiotensin II Type 1 Receptor Blockers/pharmacology ; Angiotensin II Type 1 Receptor Blockers/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Animals ; Drug Therapy, Combination ; Humans ; Kidney/drug effects ; Kidney/metabolism ; Proteinuria/drug therapy ; Renin-Angiotensin System/drug effects
    Chemical Substances Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2009-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2086948-4
    ISSN 1752-8976 ; 1470-3203
    ISSN (online) 1752-8976
    ISSN 1470-3203
    DOI 10.1177/1470320309102747
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  9. Article ; Online: Vasopressin receptor antagonists: Characteristics and clinical role.

    Rondon-Berrios, Helbert / Berl, Tomas

    Best practice & research. Clinical endocrinology & metabolism

    2016  Volume 30, Issue 2, Page(s) 289–303

    Abstract: Hyponatremia, the most common electrolyte disorder in hospitalized patients is associated with increased risk of mortality even when mild and apparently asymptomatic. Likewise morbidity manifested as attention deficits, gait disturbances, falls, ... ...

    Abstract Hyponatremia, the most common electrolyte disorder in hospitalized patients is associated with increased risk of mortality even when mild and apparently asymptomatic. Likewise morbidity manifested as attention deficits, gait disturbances, falls, fractures, and osteoporosis is more prevalent in hyponatremic subjects. Hyponatremia also generates a significant financial burden. Therefore, it is important to explore approaches that effectively and safely treat hyponatremia. Currently available strategies are physiologically sound and affordable but lack evidence from clinical trials and are limited by variable efficacy, slow response, and/or poor compliance. The recent emergence of vasopressin receptor antagonists provides a class of drugs that target the primary pathophysiological mechanism, namely vasopressin mediated impairment of free water excretion. This review summarizes the historical development, pharmacology, clinical trials supporting efficacy and safety, shortcomings, as well as practical suggestions for the use of vasopressin receptor antagonists.
    MeSH term(s) Antidiuretic Hormone Receptor Antagonists/administration & dosage ; Antidiuretic Hormone Receptor Antagonists/adverse effects ; Antidiuretic Hormone Receptor Antagonists/pharmacology ; Antidiuretic Hormone Receptor Antagonists/therapeutic use ; Clinical Trials as Topic ; Humans ; Hyponatremia/drug therapy ; Water-Electrolyte Balance
    Chemical Substances Antidiuretic Hormone Receptor Antagonists
    Language English
    Publishing date 2016-03
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2052339-7
    ISSN 1878-1594 ; 1532-1908 ; 1521-690X
    ISSN (online) 1878-1594 ; 1532-1908
    ISSN 1521-690X
    DOI 10.1016/j.beem.2016.02.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Maximizing inhibition of the renin-angiotensin system with high doses of converting enzyme inhibitors or angiotensin receptor blockers.

    Berl, Tomas

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2008  Volume 23, Issue 8, Page(s) 2443–2447

    MeSH term(s) Angiotensin II Type 1 Receptor Blockers/administration & dosage ; Angiotensin-Converting Enzyme Inhibitors/administration & dosage ; Diabetic Nephropathies/drug therapy ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Humans ; Kidney Diseases/drug therapy ; Proteinuria/drug therapy ; Renin-Angiotensin System/drug effects ; Safety
    Chemical Substances Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2008-08
    Publishing country England
    Document type Editorial ; Review
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfn239
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