Horacio J. Adroguee
Professor of Medicine, Baylor College of Medicine, Section of Nephrology, Houston, USA
The overall goal of my research is to deepen our understanding of disorders of fluid, electrolyte, and acid-base balance, as well as the role of sodium and potassium in the pathogenesis of primary hypertension. We have done original investigations that uncovered a number of fundamental issues, some of them listed below, including the determinants of hyperchloremic acidosis in diabetic ketoacidosis; maladaptation of the kidney in both metabolic acidosis and alkalosis; role of normal variations in PCO2 as determinants of plasma bicarbonate; changes in plasma anion gap during acid-base disorders; determinants of the changes in serum potassium in acid-base disorders; changes in bicarbonate space caused by titration of non-bicarbonate buffers; effect of respiratory and metabolic acid-base disorders on carbon dioxide titration curve in vivo; impairment in distal nephron acidification in chronic respiratory acidosis; acid-base patterns in patients with status asthmaticus; role of intracellular pH in acidification by the proton pump in turtle urinary bladder; uniformity of the ventilatory response (?PCO2 / ?HCO3?) in metabolic acid-base disorders; mechanisms of the arteriovenous acid-base disparity in circulatory failure; impairment of tissues glucose consumption in acidemic states; the salutary effects of modest fluid replacement in the management of diabetic ketoacidosis; impact of acute and chronic respiratory acid-base disorders on preexisting metabolic acidosis; demonstration of an apical chloride conductive pathway and GTP-binding proteins in turtle urinary bladder epithelial cells; mechanism of acetazolamide-induced rise in renal vascular resistance in the intact dog; and the regulation of potassium excretion in chronic renal failure.
Our interest in hyponatremia and hypernatremia led to the introduction of the Infusate formula and the Fluid-loss formula that allow quantitative projections of prescribed fluid therapy and ongoing fluid losses on the patient?s serum sodium. These simple equations known as the Adrogué-Madias formulas, have gained popularity among clinicians. More importantly, studies by other investigators have corroborated the predictive accuracy of these formulas.
Our focus on the role of sodium and potassium in the pathogenesis of hypertension allowed us to demonstrate the role of the Na+ / K+ ATPase on the K+-induced vascular relaxation; the rebound hypertension and impaired urea reduction ratio post-dialysis with low potassium dialysate; the interdependency of sodium and potassium intake in the pathogenesis of hypertension; and the role of potassium as a true antidote with respect to the non-salutary effect of sodium in primary hypertension.