Skip to main content
Erschienen in: Pediatric Nephrology 2/2009

01.02.2009 | Original Article

Nitric oxide synthase and renin–angiotensin gene expression and NOS function in the postnatal renal resistance vasculature

verfasst von: Brian Ratliff, Justin Rodebaugh, Miroslav Sekulic, Ke-Wen Dong, Michael Solhaug

Erschienen in: Pediatric Nephrology | Ausgabe 2/2009

Einloggen, um Zugang zu erhalten

Abstract

Nitric oxide (NO), produced by nitric oxide synthase (NOS), critically counteracts angiotensin-II-enhanced vascular resistance in the immature kidney, perhaps due to the developmental regulation of NOS expression and function in the postnatal preglomerular resistance vessels (PRV). Our experiments measured the messenger ribonucleic acid (mRNA) gene expression of neuronal NOS (nNOS), endothelial NOS (eNOS), and components of the renin–angiotensin system (renin, AT1 and AT2 receptors), by real-time RT-PCR, as well as NOS enzymatic activity by citrulline assay in PRVs (afferent, interlobular, and arcuate arterioles) obtained from swine ages newborn, 7 and 21 days, and adult. NOS enzymatic activity was upregulated in PRVs immediately after birth but decreased to adult levels with maturation. Neuronal NOS, renin, and AT2 receptor expression in PRVs were upregulated in the newborn and decreased with age to lowest levels in the adult. In contrast, eNOS and AT1 receptor expression were downregulated at birth but increased to the highest levels in the adult. Upregulated NOS enzymatic activity in newborn PRVs supports the critical neonatal role for NO renal vascular vasodilation. Upregulated nNOS gene expression, concomitant with downregulated eNOS gene expression in neonatal PRVs, suggests that the nNOS isoform may be responsible for counteracting angiotensin II increased vascular resistance in immature porcine PRVs.
Literatur
1.
Zurück zum Zitat Ballèvre L, Thonney M, Guignard JP (1994) Role of nitric oxide in regulating renal hemodynamics in newborn rabbits. Pediatr Nephrol 8:C42 Ballèvre L, Thonney M, Guignard JP (1994) Role of nitric oxide in regulating renal hemodynamics in newborn rabbits. Pediatr Nephrol 8:C42
2.
Zurück zum Zitat Toth-Heyn P, Drukker A, Guignard JP (2000) The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 14:227–239PubMed Toth-Heyn P, Drukker A, Guignard JP (2000) The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 14:227–239PubMed
3.
Zurück zum Zitat Norman ME, Asadi FK (1979) A prospective study of acute renal failure in the newborn infant. Pediatrics 63:475–479PubMed Norman ME, Asadi FK (1979) A prospective study of acute renal failure in the newborn infant. Pediatrics 63:475–479PubMed
4.
Zurück zum Zitat Chevalier RL, Campbell F, Brenbridge AN (1984) Prognostics factors neonatal acute renal failure. Pediatrics 74:265–272PubMed Chevalier RL, Campbell F, Brenbridge AN (1984) Prognostics factors neonatal acute renal failure. Pediatrics 74:265–272PubMed
5.
Zurück zum Zitat Stapleton FB, Jones DP, Green RS (1987) Acute renal failure in neonates: incidence, etiology and outcome. Pediatr Nephrol 1:314–320PubMed Stapleton FB, Jones DP, Green RS (1987) Acute renal failure in neonates: incidence, etiology and outcome. Pediatr Nephrol 1:314–320PubMed
6.
Zurück zum Zitat Sedman AB, Kershaw DB, Bunchman TE (1995) Recognition and management of angiotensin converting enzyme inhibitor fetopathy. Pediatr Nephrol 9:382–385PubMed Sedman AB, Kershaw DB, Bunchman TE (1995) Recognition and management of angiotensin converting enzyme inhibitor fetopathy. Pediatr Nephrol 9:382–385PubMed
7.
Zurück zum Zitat Rubin ML (1949) Maturation of renal function in childhood: clearance studies. Clin Invest 28:1144 Rubin ML (1949) Maturation of renal function in childhood: clearance studies. Clin Invest 28:1144
8.
Zurück zum Zitat Gruskin AB, Edelman CM Jr, Yuan S (1970) Maturational changes in renal blood flow in piglets. Pediatr Res 4:7–13PubMed Gruskin AB, Edelman CM Jr, Yuan S (1970) Maturational changes in renal blood flow in piglets. Pediatr Res 4:7–13PubMed
9.
Zurück zum Zitat Kleinman LI, Lubbe RJ (1972) Factors affecting the maturation of glomerular filtration rate and renal plasma flow in the newborn dog. J Physiol 223:395–409PubMedPubMedCentral Kleinman LI, Lubbe RJ (1972) Factors affecting the maturation of glomerular filtration rate and renal plasma flow in the newborn dog. J Physiol 223:395–409PubMedPubMedCentral
10.
Zurück zum Zitat Pezzati M, Danesi G, Pozzessere A, Cosenza EB, Rubaltelli FF (1998) Renal blood flow velocity in preterm and term neonates during the forth day of life: changes in relation to gestational age and birth rate. Biol Neonate 73:19–23PubMed Pezzati M, Danesi G, Pozzessere A, Cosenza EB, Rubaltelli FF (1998) Renal blood flow velocity in preterm and term neonates during the forth day of life: changes in relation to gestational age and birth rate. Biol Neonate 73:19–23PubMed
11.
Zurück zum Zitat Pokharel RP, Uetani Y, Tsuneishi S, Nakamura H (1997) Neonatal renal blood flow velocities using color doppler ultrasonography. Kobe J Med Sci 43:1–12PubMed Pokharel RP, Uetani Y, Tsuneishi S, Nakamura H (1997) Neonatal renal blood flow velocities using color doppler ultrasonography. Kobe J Med Sci 43:1–12PubMed
12.
Zurück zum Zitat Fawer CL, Torrado A, Guignard JP (1979) Maturation of renal function in full-term and premature neonates. Helv Paediatr Acta 34:11–21PubMed Fawer CL, Torrado A, Guignard JP (1979) Maturation of renal function in full-term and premature neonates. Helv Paediatr Acta 34:11–21PubMed
13.
Zurück zum Zitat Calcagno PL, Rubin ML (1963) Renal extraction of para-amminohippurate in infants and children. J Clin Invest 42:1632PubMedPubMedCentral Calcagno PL, Rubin ML (1963) Renal extraction of para-amminohippurate in infants and children. J Clin Invest 42:1632PubMedPubMedCentral
14.
Zurück zum Zitat Aperia A, Broberger O, Herin P (1974) Maturation changes in glomerular perfusion rate and glomerular filtration rate in lambs. Pediatr Res 8:758–765PubMed Aperia A, Broberger O, Herin P (1974) Maturation changes in glomerular perfusion rate and glomerular filtration rate in lambs. Pediatr Res 8:758–765PubMed
15.
Zurück zum Zitat Jose PA, Logan AG, Slotkoff LM, Lilienfield LS, Calcagno PL, Eisner GM (1971) Intrarenal blood flow distribution in canine puppies. Pediatr Res 5:335–344PubMed Jose PA, Logan AG, Slotkoff LM, Lilienfield LS, Calcagno PL, Eisner GM (1971) Intrarenal blood flow distribution in canine puppies. Pediatr Res 5:335–344PubMed
16.
Zurück zum Zitat Olbing H, Blaufox MD, Aschinberg LC, Silkalns GI, Bernstein J, Spitzer A, Edelmann CM Jr (1973) Postnatal changes in renal glomerular blood flow distribution in puppies. J Clin Invest 52:2885–2895PubMedPubMedCentral Olbing H, Blaufox MD, Aschinberg LC, Silkalns GI, Bernstein J, Spitzer A, Edelmann CM Jr (1973) Postnatal changes in renal glomerular blood flow distribution in puppies. J Clin Invest 52:2885–2895PubMedPubMedCentral
17.
Zurück zum Zitat Robillard JE, Nakamura KT (1988) Neurohormonal regulation of renal function during development. Am J Physiol 254:F771–F779PubMed Robillard JE, Nakamura KT (1988) Neurohormonal regulation of renal function during development. Am J Physiol 254:F771–F779PubMed
18.
Zurück zum Zitat Aschinberg LC, Goldsmith DI, Olbing H, Spitzer A, Edelmann CM Jr, Blaufox D (1975) Neonatal changes in renal blood flow distribution in puppies. Am J Physiol 228:1453–1461PubMed Aschinberg LC, Goldsmith DI, Olbing H, Spitzer A, Edelmann CM Jr, Blaufox D (1975) Neonatal changes in renal blood flow distribution in puppies. Am J Physiol 228:1453–1461PubMed
19.
Zurück zum Zitat Horster M, Valtin H (1971) Postnatal development of renal function: micropuncture and clearance studies in the dog. J Clin Invest 50:779–795PubMedPubMedCentral Horster M, Valtin H (1971) Postnatal development of renal function: micropuncture and clearance studies in the dog. J Clin Invest 50:779–795PubMedPubMedCentral
20.
Zurück zum Zitat Solhaug MJ, Ballevre LD, Guignard JP, Granger JP, Adelman RD (1996) Nitric oxide in the developing kidney. Pediatr Nephrol 10:529–539PubMed Solhaug MJ, Ballevre LD, Guignard JP, Granger JP, Adelman RD (1996) Nitric oxide in the developing kidney. Pediatr Nephrol 10:529–539PubMed
21.
Zurück zum Zitat Solhaug MJ, Wallace MR, Granger JP (1996) Nitric oxide and angiotensin II regulation of renal hemodynamics in the developing piglet. Pediatr Res 39:527–533PubMed Solhaug MJ, Wallace MR, Granger JP (1996) Nitric oxide and angiotensin II regulation of renal hemodynamics in the developing piglet. Pediatr Res 39:527–533PubMed
22.
Zurück zum Zitat Guignard JP, Gouyon JB, John EG (1991) Vasoactive factors in the immature kidney. Pediatr Nephrol 5:443–446PubMed Guignard JP, Gouyon JB, John EG (1991) Vasoactive factors in the immature kidney. Pediatr Nephrol 5:443–446PubMed
23.
Zurück zum Zitat Osborn JL, Hook JB, Bailie MD (1980) Regulation of plasma renin in developing piglets. Dev Pharmacol Ther 1:217–228PubMed Osborn JL, Hook JB, Bailie MD (1980) Regulation of plasma renin in developing piglets. Dev Pharmacol Ther 1:217–228PubMed
24.
Zurück zum Zitat Pelayo JC, Eisner GM, Jose PA (1981) The ontogeny of the renin-angiotensin system. Clin Perinatol 8:347–359PubMed Pelayo JC, Eisner GM, Jose PA (1981) The ontogeny of the renin-angiotensin system. Clin Perinatol 8:347–359PubMed
25.
Zurück zum Zitat Sulyok E, Nemeth M, Tenyi I, Csaba I, Gyory E, Ertl T, Varga F (1979) Postnatal development of the renin-angiotensin-aldosterone system, RAAS, in relation to electrolyte balance in premature infants. Pediatr Res 13:817–820PubMed Sulyok E, Nemeth M, Tenyi I, Csaba I, Gyory E, Ertl T, Varga F (1979) Postnatal development of the renin-angiotensin-aldosterone system, RAAS, in relation to electrolyte balance in premature infants. Pediatr Res 13:817–820PubMed
26.
Zurück zum Zitat Wallace KB (1980) Postnatal development of the renin-angiotensin system in rats. Am J Physiol 238:R432–R437PubMed Wallace KB (1980) Postnatal development of the renin-angiotensin system in rats. Am J Physiol 238:R432–R437PubMed
27.
Zurück zum Zitat Gomez RA (1998) Role of angiotensin in renal vascular development. Kidney Int Suppl 67:S12–S16PubMed Gomez RA (1998) Role of angiotensin in renal vascular development. Kidney Int Suppl 67:S12–S16PubMed
28.
Zurück zum Zitat Gomez RA, Lynch KR, Chevalier RL, Wilfong N, Everett A, Carey RM, Peach MJ (1988) Renin and angiotensinogen gene expression in maturing rat kidney. Am J Physiol 254:F582–F587PubMed Gomez RA, Lynch KR, Chevalier RL, Wilfong N, Everett A, Carey RM, Peach MJ (1988) Renin and angiotensinogen gene expression in maturing rat kidney. Am J Physiol 254:F582–F587PubMed
29.
Zurück zum Zitat Gomez RA, Lynch KR, Sturgill BC, Elwood JP, Chevalier RL, Carey RM, Peach MJ (1989) Distribution of renin mRNA and its protein in the developing kidney. Am J Physiol 257:F850–F858 Gomez RA, Lynch KR, Sturgill BC, Elwood JP, Chevalier RL, Carey RM, Peach MJ (1989) Distribution of renin mRNA and its protein in the developing kidney. Am J Physiol 257:F850–F858
30.
Zurück zum Zitat Ciuffo GM, Viswanathan M, Seltzer AM, Tsutsumi K, Saavedra JM (1993) Glomerular angiotensin II receptor subtypes during development. Am J Physiol 265:F264–F271PubMed Ciuffo GM, Viswanathan M, Seltzer AM, Tsutsumi K, Saavedra JM (1993) Glomerular angiotensin II receptor subtypes during development. Am J Physiol 265:F264–F271PubMed
31.
Zurück zum Zitat Matsusaka T, Miyazaki Y, Ichikawa I (2002) The renin angiotensin system and kidney development. Annu Rev Physiol 64:551–561PubMed Matsusaka T, Miyazaki Y, Ichikawa I (2002) The renin angiotensin system and kidney development. Annu Rev Physiol 64:551–561PubMed
32.
Zurück zum Zitat Shanmugam S, Lenkei ZG, Gasc JM, Corvol PL, Llorens-Cortes CM (1995) Ontogeny of angiotensin II type 2 (AT2) receptor mRNA in the rat. Kidney Int 47:1095–1100PubMed Shanmugam S, Lenkei ZG, Gasc JM, Corvol PL, Llorens-Cortes CM (1995) Ontogeny of angiotensin II type 2 (AT2) receptor mRNA in the rat. Kidney Int 47:1095–1100PubMed
33.
Zurück zum Zitat Tufro-McReddie A, Gomez RA (1993) Ontogeny of the renin-angiotensin system. Semin Nephrol 13:519–530PubMed Tufro-McReddie A, Gomez RA (1993) Ontogeny of the renin-angiotensin system. Semin Nephrol 13:519–530PubMed
34.
Zurück zum Zitat Yoo KH, Norwood VF, el Dahr SS, Yosipiv I, Chevalier RL (1997) Regulation of angiotensin II AT1 and AT2 receptors in neonatal ureteral obstruction. Am J Physiol 273:R503–R509PubMed Yoo KH, Norwood VF, el Dahr SS, Yosipiv I, Chevalier RL (1997) Regulation of angiotensin II AT1 and AT2 receptors in neonatal ureteral obstruction. Am J Physiol 273:R503–R509PubMed
35.
Zurück zum Zitat Solhaug MJ, Wallace MR, Granger JP (1993) Endothelium-derived nitric oxide regulates renal hemodynamics in the developing piglet. Pediatr Res 34:750–754PubMed Solhaug MJ, Wallace MR, Granger JP (1993) Endothelium-derived nitric oxide regulates renal hemodynamics in the developing piglet. Pediatr Res 34:750–754PubMed
36.
Zurück zum Zitat Simeoni U, Helwig JJ (1997) Nitric oxide (NO) and normal and pathologic renal development. Pediatr Med Chir 19:313–315PubMed Simeoni U, Helwig JJ (1997) Nitric oxide (NO) and normal and pathologic renal development. Pediatr Med Chir 19:313–315PubMed
37.
Zurück zum Zitat Sener A, Smith FG (2001) Renal hemodynamic effects of L-NAME during postnatal maturation in conscious lambs. Pediatr Nephrol 16:868–873PubMed Sener A, Smith FG (2001) Renal hemodynamic effects of L-NAME during postnatal maturation in conscious lambs. Pediatr Nephrol 16:868–873PubMed
38.
Zurück zum Zitat Solhaug MJ, Dong XQ, Adelman RD, Dong KW (2000) Ontogeny of neuronal nitric oxide synthase, NOS I, in the developing porcine kidney. Am J Physiol Regul Integr Comp Physiol 278:R1453–R1459PubMed Solhaug MJ, Dong XQ, Adelman RD, Dong KW (2000) Ontogeny of neuronal nitric oxide synthase, NOS I, in the developing porcine kidney. Am J Physiol Regul Integr Comp Physiol 278:R1453–R1459PubMed
39.
Zurück zum Zitat Solhaug MJ, Kullaprawithaya U, Dong XQ, Dong KW (2001) Expression of endothelial nitric oxide synthase in the postnatal developing porcine kidney. Am J Physiol Regul Integr Comp Physiol 280:R1269–R1275PubMed Solhaug MJ, Kullaprawithaya U, Dong XQ, Dong KW (2001) Expression of endothelial nitric oxide synthase in the postnatal developing porcine kidney. Am J Physiol Regul Integr Comp Physiol 280:R1269–R1275PubMed
40.
Zurück zum Zitat Han KH, Lim JM, Kim WY, Kim H, Madsen KM, Kim J (2005) Expression of endothelial nitric oxide synthase in developing rat kidney. Am J Physiol Renal Physiol 288:F694–F702PubMed Han KH, Lim JM, Kim WY, Kim H, Madsen KM, Kim J (2005) Expression of endothelial nitric oxide synthase in developing rat kidney. Am J Physiol Renal Physiol 288:F694–F702PubMed
41.
Zurück zum Zitat Bachmann S, Bosse HM, Mundel P (1995) Topography of nitric oxide synthesis by localizing constitutive NO synthases in mammalian kidney. Am J Physiol 268:F885–F898PubMed Bachmann S, Bosse HM, Mundel P (1995) Topography of nitric oxide synthesis by localizing constitutive NO synthases in mammalian kidney. Am J Physiol 268:F885–F898PubMed
42.
Zurück zum Zitat Mattson DL, Wu F (2000) Nitric oxide synthase activity and isoforms in rat renal vasculature. Hypertension 35:337–341PubMed Mattson DL, Wu F (2000) Nitric oxide synthase activity and isoforms in rat renal vasculature. Hypertension 35:337–341PubMed
43.
Zurück zum Zitat Terada Y, Tomita K, Nonoguchi H, Marumo F (1992) Polymerase chain reaction localization of constitutive nitric oxide synthase and soluble guanylate cyclase messenger RNAs in microdissected rat nephron segments. J Clin Invest 90:659–665PubMedPubMedCentral Terada Y, Tomita K, Nonoguchi H, Marumo F (1992) Polymerase chain reaction localization of constitutive nitric oxide synthase and soluble guanylate cyclase messenger RNAs in microdissected rat nephron segments. J Clin Invest 90:659–665PubMedPubMedCentral
44.
Zurück zum Zitat Ujiie K, Yuen J, Hogarth L, Danziger R, Star RA (1994) Localization and regulation of endothelial NO synthase mRNA expression in rat kidney. Am J Physiol 267:F296–F302PubMed Ujiie K, Yuen J, Hogarth L, Danziger R, Star RA (1994) Localization and regulation of endothelial NO synthase mRNA expression in rat kidney. Am J Physiol 267:F296–F302PubMed
45.
Zurück zum Zitat Kone BC (1999) Localization and regulation of nitric oxide synthase isoforms in the kidney. Semin Nephrol 19:230–241PubMed Kone BC (1999) Localization and regulation of nitric oxide synthase isoforms in the kidney. Semin Nephrol 19:230–241PubMed
46.
Zurück zum Zitat Pelayo JC, Mobilia M, Tjio S, Singh R, Nakamoto JM, Van Dop C (1994) A method for isolation of rat renal microvessels and mRNA localization. Am J Physiol Renal Physiol 267:F497–F503 Pelayo JC, Mobilia M, Tjio S, Singh R, Nakamoto JM, Van Dop C (1994) A method for isolation of rat renal microvessels and mRNA localization. Am J Physiol Renal Physiol 267:F497–F503
47.
Zurück zum Zitat Bosse HM, Bohm R, Resch S, Bachmann S (1995) Parallel regulation of constitutive NO synthase and renin at JGA of rat kidney under various stimuli. Am J Physiol 269:F793–F805PubMed Bosse HM, Bohm R, Resch S, Bachmann S (1995) Parallel regulation of constitutive NO synthase and renin at JGA of rat kidney under various stimuli. Am J Physiol 269:F793–F805PubMed
48.
Zurück zum Zitat Gabbai FB, Blantz RC (2002) Role of nitric oxide in renal hemodynamics. Semin Nephrol 19:242–250 Gabbai FB, Blantz RC (2002) Role of nitric oxide in renal hemodynamics. Semin Nephrol 19:242–250
49.
Zurück zum Zitat Schricker K, Potzl B, Hamann M, Kurtz A (1996) Coordinate changes of renin and brain-type nitric-oxide-synthase (b- NOS) mRNA levels in rat kidneys. Pflugers Arch 432:394–400PubMed Schricker K, Potzl B, Hamann M, Kurtz A (1996) Coordinate changes of renin and brain-type nitric-oxide-synthase (b- NOS) mRNA levels in rat kidneys. Pflugers Arch 432:394–400PubMed
50.
Zurück zum Zitat Singh I, Grams M, Wang WH, Yang T, Killen P, Smart A, Schnermann J, Briggs JP (1996) Coordinate regulation of renal expression of nitric oxide synthase, renin, and angiotensinogen mRNA by dietary salt. Am J Physiol 270:F1027–F1037PubMed Singh I, Grams M, Wang WH, Yang T, Killen P, Smart A, Schnermann J, Briggs JP (1996) Coordinate regulation of renal expression of nitric oxide synthase, renin, and angiotensinogen mRNA by dietary salt. Am J Physiol 270:F1027–F1037PubMed
51.
Zurück zum Zitat Christopherson KS, Hillier BJ, Lim WA, Bredt DS (1999) PSD-95 assembles a ternary complex with the N-methyl-D-aspartic acid receptor and a bivalent neuronal NO synthase PDZ domain. J Biol Chem 274:27467–27473PubMed Christopherson KS, Hillier BJ, Lim WA, Bredt DS (1999) PSD-95 assembles a ternary complex with the N-methyl-D-aspartic acid receptor and a bivalent neuronal NO synthase PDZ domain. J Biol Chem 274:27467–27473PubMed
52.
Zurück zum Zitat Herrera M, Garvin JL (2005) Recent advances in the regulation of nitric oxide in the kidney. Hypertension 45:1062–1067PubMed Herrera M, Garvin JL (2005) Recent advances in the regulation of nitric oxide in the kidney. Hypertension 45:1062–1067PubMed
Metadaten
Titel
Nitric oxide synthase and renin–angiotensin gene expression and NOS function in the postnatal renal resistance vasculature
verfasst von
Brian Ratliff
Justin Rodebaugh
Miroslav Sekulic
Ke-Wen Dong
Michael Solhaug
Publikationsdatum
01.02.2009
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 2/2009
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-008-0977-9

Weitere Artikel der Ausgabe 2/2009

Pediatric Nephrology 2/2009 Zur Ausgabe

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.