- Email: [email protected]
15. Relative rates of renal excretion of sodium and chloride ions in normal, hypertensive and heart failure subjects
Southern
Society for Clinical
stumps of the kidney dog’s aorta and vena cava were then ligated and severed, thus completing the isolation of the kidney without its being at any time subjected to ischemia. The perfusion pressure was varied by a suitable clamp on the femoral artery of the donor dog, the pressure being lowered for one-half to two minutes to a given level and then returned to the control pressure. Control flows averaged 230 ml/min./l00 Gm. of kidney (range 115 to 450) at arteriovenous differences of pressure of 120 mm. Hg. Satisfactory plots of flow vs. A-V difference of pressure were obtained ‘in seven experiments. Of these only one gave a curve concave to the pressure axis as described by Selkurt. Two were convex and the remainder were straight. All tended to intercept zero flow at approximately 20 mm. Hg pressure. Conclusion. In the isolated kidney no evidence of autoregulation of flow was observed. 15.
RELATIVE RATES OF RENAL EXCRETION OF SODIUM AND CHLORIDE IONS IN NORMAL, HYPERTENSIVE AND HEART FAILURE SUBJECTS
ANDREW J. J.
CRUTCHFIELD, M.D. (introduced Edwin Wood, Jr., M.D.)
by
From the University of Virginia School of Medicine, Charlottesville, Va. Certain clinical and laboratory evidence suggests that renal retention of the sodium ion ranks among the primary events in the pathogenesis of the edema of congestive heart failure. The role of other extracellular electrolytes chloride), though considered to be of (e.g., lesser importance, has received little attention. Experiments have been done in this laboratory to compare the relative rates of excretion of the sodium and chloride ions. The patients studied were grouped as follows: (1) normal, twentyeight; (2) hypertensive without heart failure or clinical nephrosclerosis, eighteen and (3) edematous and non-edematous heart failure, twenty-five. The load of sodium chloride injected intravenously as 5 per cent solution actually contained 3,930 mg. of sodium and 6,070 mg. of chloride. The average figures for the per cent of the load excreted over the five hour experiment period were as follows: AMERICAN
JOURNAL
OF
MEDICINE
461
Research
(1) Normal.. (2) Hypertensive. (3) Heart Failure.
Na Per Cent
Cl Per Cent
20.1 19.2
19.2 19.4
9.0
10.1
These data indicate that the kidney of the heart failure patient excretes both sodium and chloride less rapidly than does the kidney of either the normal or hypertensive subject. Sodium excretion appears to be retarded slightly more than is chloride excretion although the difference is of doubtful significance. About one third of the hypertensives had been treated for several months on low sodium diets similar to the ones used in treating the heart failure subjects. The normal sodium and chloride excretion by these subjects indicated that this type diet did not lead to body fluid deficit of either of these ions. It can safely be assumed, therefore, that the small excretion of sodium and chloride by the heart failure subject gave a true index of the existing renal ability to excrete these substances rather than indicating body fluid deficit of these substances. 16.
EFFECT OF HUMAN SERUM ALBUMIN ON RENAL
HEMODYNAMICS AND THE TUBU-
LAR EXTRACTION OF PARA-AMINO
HIP-
PURIC ACID WAI.TER H. CARGILL, M.D. (introduced by Eugene A. Stead, Jr., M.D.) From the Department of Medicine, Duke University School of Medicine, Durham, N. C. (This work was supported by grants from the Life Insurance Medical Research Fund and the Anna H. Hanes Fund.) The intravenous administration of human serum albumin has been shown to produce a diuresis in patients with nephrosis. This has usually been attributed to a rise in plasma protein level and increased oncotic pressure of the blood. In an attempt to determine the immediate effect of albumin administration on the kidney, we have measured the inulin and para-amino hippuric acid clearance in two patients with nephrosis, five subjects with normal renal function, two hypertensives and one patient with subacute glomerulonephritis before, during and after the rapid intravenous administration of 300 cc. of a 25 per cent solution
Society for Clinical
stumps of the kidney dog’s aorta and vena cava were then ligated and severed, thus completing the isolation of the kidney without its being at any time subjected to ischemia. The perfusion pressure was varied by a suitable clamp on the femoral artery of the donor dog, the pressure being lowered for one-half to two minutes to a given level and then returned to the control pressure. Control flows averaged 230 ml/min./l00 Gm. of kidney (range 115 to 450) at arteriovenous differences of pressure of 120 mm. Hg. Satisfactory plots of flow vs. A-V difference of pressure were obtained ‘in seven experiments. Of these only one gave a curve concave to the pressure axis as described by Selkurt. Two were convex and the remainder were straight. All tended to intercept zero flow at approximately 20 mm. Hg pressure. Conclusion. In the isolated kidney no evidence of autoregulation of flow was observed. 15.
RELATIVE RATES OF RENAL EXCRETION OF SODIUM AND CHLORIDE IONS IN NORMAL, HYPERTENSIVE AND HEART FAILURE SUBJECTS
ANDREW J. J.
CRUTCHFIELD, M.D. (introduced Edwin Wood, Jr., M.D.)
by
From the University of Virginia School of Medicine, Charlottesville, Va. Certain clinical and laboratory evidence suggests that renal retention of the sodium ion ranks among the primary events in the pathogenesis of the edema of congestive heart failure. The role of other extracellular electrolytes chloride), though considered to be of (e.g., lesser importance, has received little attention. Experiments have been done in this laboratory to compare the relative rates of excretion of the sodium and chloride ions. The patients studied were grouped as follows: (1) normal, twentyeight; (2) hypertensive without heart failure or clinical nephrosclerosis, eighteen and (3) edematous and non-edematous heart failure, twenty-five. The load of sodium chloride injected intravenously as 5 per cent solution actually contained 3,930 mg. of sodium and 6,070 mg. of chloride. The average figures for the per cent of the load excreted over the five hour experiment period were as follows: AMERICAN
JOURNAL
OF
MEDICINE
461
Research
(1) Normal.. (2) Hypertensive. (3) Heart Failure.
Na Per Cent
Cl Per Cent
20.1 19.2
19.2 19.4
9.0
10.1
These data indicate that the kidney of the heart failure patient excretes both sodium and chloride less rapidly than does the kidney of either the normal or hypertensive subject. Sodium excretion appears to be retarded slightly more than is chloride excretion although the difference is of doubtful significance. About one third of the hypertensives had been treated for several months on low sodium diets similar to the ones used in treating the heart failure subjects. The normal sodium and chloride excretion by these subjects indicated that this type diet did not lead to body fluid deficit of either of these ions. It can safely be assumed, therefore, that the small excretion of sodium and chloride by the heart failure subject gave a true index of the existing renal ability to excrete these substances rather than indicating body fluid deficit of these substances. 16.
EFFECT OF HUMAN SERUM ALBUMIN ON RENAL
HEMODYNAMICS AND THE TUBU-
LAR EXTRACTION OF PARA-AMINO
HIP-
PURIC ACID WAI.TER H. CARGILL, M.D. (introduced by Eugene A. Stead, Jr., M.D.) From the Department of Medicine, Duke University School of Medicine, Durham, N. C. (This work was supported by grants from the Life Insurance Medical Research Fund and the Anna H. Hanes Fund.) The intravenous administration of human serum albumin has been shown to produce a diuresis in patients with nephrosis. This has usually been attributed to a rise in plasma protein level and increased oncotic pressure of the blood. In an attempt to determine the immediate effect of albumin administration on the kidney, we have measured the inulin and para-amino hippuric acid clearance in two patients with nephrosis, five subjects with normal renal function, two hypertensives and one patient with subacute glomerulonephritis before, during and after the rapid intravenous administration of 300 cc. of a 25 per cent solution