Dear Adnane,

I was brought up with the concept and it is still sometimes used when patients with severe nephrogenic pulmonary oedema are waiting for transfer to a dialysis unit or if intensive care is delayed to take our patients. As the NO release will dilate capacitance vessels in the lower limbs, it will reduce preload, which in itself decreases pulmonary capillary hydrostatic pressure, and as such fluid transudation into the interstitium and alveoli. 

Best wishes,

Immo

Thanks for your answer dear sir,

But are there any studies in the literature that corroborate this pathophysiological concept??

Dear Adnane,

Nitroglycerine and related drugs have been used in therapeutics at least since the late 1870s when William Murrell experimented with its use in angina. A lot of the literature regarding its pharamcodynamics and particular their effect on smooth muscle dilation goes back many decades.

A web search brings up the following articles that you may find helpful, explaining the effect on capacity vessels (and others):

Mason D, Braunwald E. The Effects of Nitroglycerin and Amyl Nitrite on Arteriolar and Venous Tone in the Human Forearm. Circulation. 1965;32:755-766

http://circ.ahajournals.org/content/32/5/755.full.pdf

Mackenzie, JE, Parratt JR. Comparative Effects of Glyceryl Trinitrate on Venous and Arterial Smooth Muscle in vitro. Br. J. Pharmac. (1977), 60, 155-160

http://onlinelibrary.wiley.com/doi/10.1111/j.1476-5381.1977.tb16760.x/pdf

Robinson BF. Assessment of the Effect of Drugs on the Venous System in Man. Br. J. clin. Pharmac. (1978), 6, 381-386

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.1978.tb04600.x/epdf

The rest is explained well through the physiology of the pulmonary capillary pressure.

Best wishes,

Immo

Well I wasn't actually meaning these kind of studies but a one that would the compare the use of NO in nephrogenic puulmonary edema to its non-use. Thanks a lot for your time dear Sir.

i have not come across any specific study of NO in nephrogenic pulm edema, but surely it may be of some help to reduce the pulm. edema of fluid overload, but to be used with caution 

The use of nitrates in treatment of pulmonary edema is based on its pharmacological potent vasodilatory effect with decreasing preload and afterload. There is no clinical evidence on its use in nephrogenic pulmonary edema. (It may be used to buy some time, but the definitive treatment is usually dialysis). Even, in acute heart failure, the current evidence concerning the use of nitrates is based on few low-quality studies.

http://www.ncbi.nlm.nih.gov/pubmed/23922186

Dear  Dr. Adnane Lahlou,  the  mechanism  of  cardiogenic pulmonary  oedema  and  the  mechanism  of  Nephrogenic  oedema  pulmonary  are  entirely  different. In  cardiogenic  pulmonary  oedema,  the  total  circulatory  volume  in  the  body  is  normal  or  low.  There  is  wrong  distribution  of  fluid  from  the  intra vascular ( right ) compartment  to  Pulmonary  ( alveolar / interstitial)  compartment  ( wrong ) due  to  decreased  cardiac  pumping and  hence  methods  of  increasing  cardiac  pumping  ability  by  augmenting  the  coronary  flow, decreasing  the  preload  as  well  the afterload  by  Nitroglycerine (  a  pan vasodilator ) is  of  definite help.  In  case  of  Nephrogenic  pulmonary  oedema  the  total  circulatory  volume  including  the  intravascular  and  pulmonary  compartment  fluid  volume  all  increase, in  which  case  either  Haemodialysis,  the  first  Choice or  Mechanical  Ventilation  with   a high  PEEP as  alternate  option is  the Scientific  method  of  managing  the  Pulmonary  oedema. However  when  accelerated  Hypertension  is  a precipitating  factor  of  Acute  Kidney  Injury  on  Chronic  Kidney  disease with  Pulmonary  oedema  Nitroglycerine  is  bound  to  work  by  reducing  the  accelerated  hypertension  rapidly  to  normal  levels.

Thanks sir for the well explained answer