INFLUENCE OF EXPANSION OF EXTRACELLULAR VOLUME ON TUBULAR REABSORPTION OF SODIUM INDEPENDENT OF CHANGES IN GLOMERULAR FILTRATION RATE AND ALDOSTERONE ACTIVITY

Marinobufagenin, resibufogenin and preeclampsia

The bufodienolides are cardiac glycosides which have the ability to inhibit the enzyme, Na(+)/K(+) ATPase (sodium potassium adenosine triphosphatase). They are cardiac inotropes, cause vasoconstriction (and, potentially, hypertension) and are natriuretic. Evidence has accrued over time which supports the view that they are mechanistically involved in volume expansion-mediated hypertension. In this communication, the authors summarize data which support the view that the bufodienolides and, in particular, marinobufagenin (MBG) are involved in the pathogenesis of preeclampsia. In a rat model of the syndrome, MBG causes hypertension, proteinuria, intrauterine growth restriction and increased weight gain. All of these phenotypic characteristics are prevented by an antagonist to MBG, resibufogenin (RBG). The "preeclamptic" animals also develop a vascular leak syndrome, resulting in hemoconcentration. Abnormalities in the MAPK (mitogen-activated protein kinase) system play a role in the mechanism by which MBG produces the abnormalities in the pregnant rat. Studies to discover the relevance of these findings to human preeclampsia are currently underway in several laboratories and clinics.

Clinical pharmacology of antibiotics and other drugs in cystic fibrosis

The disposition of many drugs in cystic fibrosis is abnormal. In general, changes in pharmacokinetics include: increased volume of distribution, decreased plasma concentration, and enhanced renal and sometimes non-renal elimination of drugs. Pathophysiology of the disease important for drug disposition includes: (a) hypersecretion of gastric acid and duodenal secretions which are of small volume, viscous and low in bicarbonate; (b) increased intestinal permeability to some sugars and probe substances; (c) hypergammaglobulinaemia and sometimes hypoalbuminaemia; (d) significant elevation of free fatty palmitoleic acid level and decreased low-density and high-density serum lipoproteins; (e) an average increase by 30 to 45% in plasma volume in patients with cystic fibrosis who have moderately severe pulmonary disease, right ventricle hypertrophy and dilatation, which occurs in 15 to 35% of patients with a Shwachman score of 81 to 100; (f) abnormal bile acid metabolism and enterohepatic recirculation; and (g) enlarged kidneys and glomerulomegaly with increased glomerular filtration rate, tubular clearance and urine flow rate in some patients with cystic fibrosis. Delayed absorption from the gastrointestinal tract has been reported in patients with cystic fibrosis for cloxacillin, epicillin, clindamycin, ciprofloxacin and probably for cephalexin, para-aminobenzoic acid and chloramphenicol. A possible increased absorption was reported for cimetidine. Of 7 drugs studied only theophylline had significantly decreased plasma protein binding. An increased volume of distribution and increased renal clearance reported for several drugs is caused mainly by increases in plasma volume and urine flow rate in many of these patients. Possible increased elimination of some drugs in bile (which probably results from bile acid malabsorption) and in bronchial secretions (which are abundant in some cystic fibrosis patients with acute pulmonary infection) may explain enhanced non-renal elimination of these drugs. The metabolism of cimetidine in cystic fibrosis was reported not to be changed significantly compared to control subjects.

Site and magnitude of the tubular inhibitory effect of expanding the extracellular volume in dogs

Ethacrynic acid inhibits energy-requiring transcellular NaCl reabsorption without affecting NaHCO3 reabsorption. Acetazolamide inhibits NaHCO3 and most of the remaining NaCl reabsorption in the proximal tubules (bicarbonate-dependent reabsorption) but raises distal transcellular NaCl reabsorption. After administration of both diuretics, the remaining bicarbonate-dependent and transcellular reabsorptions become constant until glomerular filtration rate (GFR) is almost halved. The inhibitory effect of expanding the extracellular volume (ECV) until plasma volume and GFR increased 30-40% was examined in anesthetized dogs. Examinations at comparable GFR obtained by altering arterial perfusion pressure showed that the inhibitory effect of ECV expansion was attenuated by administering acetazolamide. Ethacrynic acid amplified the inhibitory effect which for sodium and chloride reabsorption amounted to 6-7% of the filtered load at comparable GFR. An inhibitory effect of ECV expansion of bicarbonate reabsorption was disclosed only after raising plasma bicarbonate concentration. Thus, the small inhibitory effect of massive ECV expansion is confined to proximal tubular bicarbonate-dependent reabsorption and is of the same magnitude as previously demonstrated in experiments of similar design by raising plasma pH by only 0.07 unit. Since ouabain inhibits transcellular NaCl reabsorption, a natriuretic hormone is more likely to be an inhibitor of carbonic anhydrase than of Na,K-ATPase.

Renal clearance of digoxin in man after sodium loading or furosemide treatment

To evaluate the influence of different types of natriuresis on the renal clearance of digoxin (Cldig) and the Cldig/Clcr ratio, studies were performed in which sodium-depleted patients were placed on a moderately high sodium diet for 6 days. In another group natriuresis was evoked by furosemide. In the first study, in 10 patients, there was a 10-fold increase in Na excretion and a small rise in diuresis (V) and Clcr, which was accompanied by an increase in Cldig from 57.5 +/- 32, and 60.7 +/- 27.3 (duplicate measurements) to 103.9 +/- 55.4 (p less than 0.01) and 103.8 +/- 46.5 ml min-1 (p less than 0.01). Cldig/Clcr rose from 0.60 +/- 0.24 and 0.61 +/- 0.16 to 0.91 +/- 0.31 and 0.91 +/- 0.21, respectively (both p less than 0.005). Serum digoxin concentration declined from 1.24 +/- 0.35 and 1.19 +/- 0.40 to 1.02 +/- 0.35 and 0.97 +/- 0.32 micrograms/l (both p less than 0.01) during the high sodium diet. In the furosemide-induced natriuresis (6 patients), changes in Na excretion and V were a multiple of those caused by Na loading, but the Cldig/Clcr ratio was not increased. The results are in accordance with the concept of digoxin backdiffusion in the proximal tubules, which is dependent on proximal Na reabsorption. In the more distal segments of the nephron, where the action of furosemide occurs, there does not appear to be any transtubular movement of digoxin.

Urine flow-dependence of theophylline renal clearance in man

Theophylline renal clearance is highly dependent on urine flow rate and is neither concentration nor dose related. To examine the flow dependency, theophylline was administered in single doses (4.3 mg/kg to 8.6 mg/kg) to 14 volunteers. Seven of these volunteers participated in studies in which theophylline and metabolite concentrations were held constant at six different levels. Due to the diuretic effect of theophylline, its renal clearance contributed up to 70% of the time-averaged total clearance, dose/total area, in the first hour after a single dose. The contribution then dropped to 5% of the time-averaged total clearance when the normal urine flow rate was restored. As a consequence of extensive tubular reabsorption, the urine/plasma concentration ratio of theophylline varied with urine flow rate and approached the value of the unbound fraction in plasma. On assumption that the reabsorption is passive, a mathematical model was used to explain the urine flow dependence of reabsorption and, therefore, the renal clearance of theophylline.

Influence of uranyl nitrate upon tubular reabsorption and glomerular filtration in blood perfused isolated dog kidneys

The early changes in tubular reabsorption, glomerular filtration, blood flow and sodium excretion brought about by uranyl nitrate were investigated in isolated, blood-perfused dog kidneys during water diuresis. No significant changes in urine volume were observed; the decrease in fluid reabsorption was counterbalanced quantitatively by a reduction in glomerular filtration rate; only a small diminution of renal blood flow was found. The balance between reabsorption and filtration was observed as well when angiotensin action or prostaglandin synthesis were inhibited. The intrarenal venous pressure rose, suggesting that an increase in proximal intratubular hydrostatic pressure caused the decrease in filtration. Tubular back-leak of fluid, or back-diffusion, induced by the toxin, were excluded. The presence of natriuretic compounds in the urine was confirmed.

Connection between the changes in tubular reabsorption and in glomerular filtration rate induced by replacement of plasma sodium and chloride by isotonic mannitol

Glomerular filtration and tubular reabsorption have been investigated comparatively in isolated blood-perfused dog kidneys, after addition to the blood of equal volumes of isotonic sodium chloride or isotonic mannitol. In the absence of antidiuretic hormone activity, the urine output showed no significant difference, while the glomerular filtration rate was lower in the presence of the mannitol load. The inhibition of fluid reabsorption was compensated by the decrease of filtration; a quantitative tubulo-glomerular equilibrium was evidenced. The fractional sodium excretion was decreased following the dilution by the mannitol load of plasma sodium and -chloride; this difference disappeared when the reabsorption in the diluting segment was inhibited by furosemide, suggesting that it depended on the rate of chloride reabsorption in this part of the tubule.

Influence of replacement of chloride by sulphate upon urine excretion and glomerular filtration rate in blood perfused isolated dog kidneys

Tubular reabsorption was inhibited in isolated dog kidneys by the progressive substitution of plasma chloride by sulphate. In the absence of antidiuretic hormone activity, urine output remained unchanged owing to an equivalent decrease in glomerular filtration rate. This equilibrium was demonstrated under conditions of "saline natriuresis" and was not disturbed by furosemide. Although the impairment of glomerular filtration rate was accompanied by a decrease of total renal blood flow, the equilibrium was not disrupted by angiotensin antagonism. Sodium excretion was enhanced by low plasma chloride concentrations in the absence, but not in the presence of furosemide. The results are not compatible with a specific role of osmolality, sodium or chloride concentrations in the tubular fluid in the adjustment of glomerular filtration. Simultaneous changes in blood flow and tubular flow resistances might explain the results. It is suggested that, in contrast to the mechanism of tubulo-glomerular feedback found in individual nephrons of hydropenic animals, this intrarenal mechanism might serve to protect the organism against sodium loss under conditions of high intake.

Sodium balance in very low-birth-weight infants

Sodium balance was studied in 17 consecutively admitted neonates weighing less than 1,200 gm at birth. Infants whose gestation was less than or equal to 30 weeks were sicker and were in markedly negative sodium balance on day 3 (-9.25 mEq/kg day), despite a high sodium intake (7.22 mEq/kg/day). This negative balance was the result of a high fractional sodium excretion and resulted in hyponatremia in six (50%) of the patients. By day 8 these immature infants were in positive sodium balance, although fractional sodium excretion and daily sodium requirements remained high. More mature infants (greater than 30 weeks gestational age) were in positive sodium balance on both days 3 and 8. Creatinine clearance did not differ significantly between groups on either day 3 or 8 but increased within each group during the study period. These data suggest that the daily sodium requirement of immature sick infants may be much higher than was previously suggested.

The kallikrein-kinin system in Bartter's syndrome and its response to prostaglandin synthetase inhibition

The kallikrein-kinin system was characterized in seven patients with Bartter's syndrome on constant metabolic regimens before, during, and after treatment with prostaglandin synthetase inhibitors. Patients with Bartter's syndrome had high values for plasma bradykinin, plasma renin activity (PRA), urinary kallikrein, urinary immunoreactive prostaglandin E excretion, and urinary aldosterone; urinary kinins were subnormal and plasma prekallikrein was normal. Treatment with indomethacin or ibuprofen which decreased urinary immunoreactive prostaglandin E excretion by 67%, decreased mean PRA (patients recumbent) from 17.3+/-5.3 (S.E.M.) ng/ml per h to 3.3+/-1.1 ng/ml per h, mean plasma bradykinin (patients recumbent) from 15.4+/-4.4 ng/ml to 3.9+/-0.9 ng/ml, mean urinary kallikrein excretion from 24.8+/-3.2 tosyl-arginine-methyl ester units (TU)/day to 12.4+/-2.0 TU/day, but increased mean urinary kinin excretion from 3.8+/-1.3 mug/day to 8.5+/-2.5 mug/day. Plasma prekallikrein remained unchanged at 1.4 TU/ml. Thus, with prostaglandin synthetase inhibition, values for urinary kallikrein and kinin and plasma bradykinin returned to normal pari passu with changes in PRA, in aldosterone, and in prostaglandin E. The results suggest that, in Bartter's syndrome, prostaglandins mediate the low urinary kinins and the high plasma bradykinin, and that urinary kallikrein, which is aldosterone dependent, does not control kinin excretion. The high plasma bradykinin may be a cause of the pressor hyporesponsiveness to angiotensin II which characterizes the syndrome.

Effects of prostaglandin inhibition on intrarenal hemodynamics in acutely saline-loaded rats

We studied the effect of inhibition of the prostaglandin (PG)-synthesizing enzyme system in female Sprague-Dawley rats following acute expansion of the extracellular fluid volume (ECV). In 57 conscious rats expansion of the ECV with isotonic saline corresponding to an increase in body weight of 10% was induced. Prior to ECV expansion 31 rats received indomethacin (10 mg/kg of body wt) by stomach tube. In six non-ECV-expanded rats indomethacin had no effect on glomerular filtration rate (GFR) and renal plasma flow (RPF). In ECV-expanded rats pretreated with indomethacin, GFR was unaltered but 125I-hippuran clearance decreased, and filtration fraction significantly increased. Intrarenal 86Rb distribution was similar in control and ECV-expanded rats. Indomethacin caused a slight increase in relative cortical 86 RB activity in non-ECV-expanded rats, but had no effect on intrarenal 86Rb distribution in ECV-expanded rats. No difference in intracortical glomerular perfusion was noted between control and ECV-expanded rats. In indomethacin-treated ECV-expanded rats an increase in relative inner cortical perfusion was observed. Absolute perfusion remained unaltered. Thus the decrease in total RPF was entirely due to decreased perfusion of outer cortical nephrons. Renal prostaglandins therefore may play a permissive role for physical factors to promote renal sodium excretion in acute ECV expansion via changes in intrarenal hemodynamics.

Renal Na-K-ATPase activity during saline infusion in the rabbit

During saline infusion, sodium reabsorption (RNa) in the diluting segment (thick ascending limb of Henle's loop) increases acutely. The mechanism for this higher pumping rate of outer medullary Na-K-ATPase is unknown. Following left-sided nephrectomy, immediate i.v. infusion of hypertonic saline increased RNa in the remaining whole right kidney by 28 +/- 14% (p less than 0.05). Na-K-ATPase activity in outer medulla was raised by (delta) 23 +/- 4% above the left kidney (p less than 0.05), whereas cortical activity was unchanged. The mechanism for this increase in Na-K-ATPase activity was explored. The catalytic rate per enzyme did not differ in the two kidneys and equalled 5 340 min-1. The increase was therefore due to higher tissue concentration of active enzyme. The response was fully developed during continuous infusion within 20 min, and of equal magnitude whether protein synthesis had been inhibited by cycloheximide (delta = 23 +/- 7%) or stimulated by unilateral nephrectomy 6 days earlier combined with saline infusion for 2 h (delta = 34 +/- 10%). Thus, during hypertonic saline infusion, the increased RNa in the outer medulla was partly accounted for by the activation of latent Na-K-ATPase. High delivery of sodium to the diluting segment for more than 20 min during hypertrophy caused no further activity change.

Excretion of sodium and water by kidneys in situ and by transplanted kidneys following isotonic, hypotonic, iso-oncotic and hyperoncotic intravenous infusions in sodium-loaded and sodium-deprived dogs

The excretion of sodium and water following isotonic, hypotonic, iso-oncotic and hyperoncotic intravenous infusions has been investigated in the kidneys in situ and in transplanted kidneys of narcotized dogs previously submitted to sodium-enriched or-deprived diets. The fractional excretion of sodium depended basically on the cumulative effect on the kidney of the changes in plasma oncotic pressure, plasma sodium concentration, and haematocrit. The differences in excretory responses of sodium-loaded or-deprived animals did not depend on differences in the distribution of infused fluids between intra- and extravascular compartments, but to the sensitivity of the kidney itself to the direct cumulative effect of these non-specific changes in blood composition.

Prostaglandins and renal function in acute extracellular volume expansion

Mechanisms determining the natriuresis in ECV-expansion are not yet completely understood. The present study was therefore undertaken to investigate if prostaglandins (PG) are involved in the natriuresis of acute ECV-expansion and by which mechanisms PG may affect renal Na-absorption. In non-expanded rats the PG synthetase inhibitor indomethacin (INDO) had no effect on renal function. In 37 Sprague-Dawley rats ECV-expansion with isotonic saline corresponding to an increase in b.wt. of 10% was induced. Twenty-one animals received an oral dose of 10 mg/kg b.wt. of INDO prior to ECV-expansion. Sixteen animals served as ECV-expanded controls (C). GFR (INDO: 12.5 +/- 1.0; C: 10.5 +/- 0.9 ml/min/kg b.wt.) did not significantly differ in both groups. However, total renal plasma flow (RPF) (INDO: 22.9 +/- 1.8; C: 30.1 +/- 2.7 ml/min/kg b.wt.), urinary flow rate (INDO: 1.11 +/- 0.20; C: 1.93 +/- 0.21 ml/min/kg b.wt.) and urinary excretion of sodium (INDO: 141 +/- 26; C: 267 +/- 46 muEq/min/kg b.wt.) and potassium (INDO: 13.0 +/- 0.9; C: 19.8 +/- 1.7 muEq/min/kg b.wt.) markedly decreased in animals pretreated with INDO. The results indicate that PG are involved in the natriuresis of acute ECV-expansion and suggest, that PG may inhibit the intrinsic capacity for Na-absorption in more proximal parts of the nephron possibly via intrarenal physical factors.

Influence of ethacrynic acid on intrarenal renin release mechanisms

Ethacrynic acid infused i.v. in anesthetized dogs after inhibiting sympathetic mechanisms of renin release increased renal blood flow rate (RBF) by 54% and practically abolished autoregulation of RBF; renin release increased from 0.8 +/- 0.9 (mean +/- SEM) to 16.4 +/- 3.7 mug/min (P less than 0.05). Without infusion of ethacrynic acid; constriction of the renal artery to a pressure below the range of autoregulation reduced renovascular resistance markedly and renin release rose to 27.2 +/- 5.5 mug/min (P less than 0.05). During arterial constriction, ethacrynic acid had no additional effect on renovascular resistance or renin release averaging 28.4 +/- 6.7 mug/min. Infusion of ethacrynic acid and saline at control pressure increased sodium excretion to about one-half of the filtrate and reduced rein release which did not, however, return to control. Infusion of hypertonic saline during autoregulated vasodilatation induced by arterial constriction had a similar effect, but again renin release continued to exceed control. We propose that ethacrynic acid increases renin release through a hemodynamic mechanism triggered by afferent arteriolar dilation and inhibits renin release by greatly increasing the delivery of sodium to the distal convoluted tubules.

Changes in renal hemodynamics and sodium excretion during saline infusion in lambs

The renal response to a progressive isotonic extracellular volume (ECV) expansion was studied in 13 lambs of two age groups (5-28 days and 48-57 days). Changes in renal hemodynamics induced by the ECV expansion were followed. Intrarenal blood flow was determined by the microsphere method. For determination of the glomerular filtration rate (GFR) standard clearance techniques were used. Recordings were made during control conditions and when normal saline had been infused in amounts up to 4.5% of the body weight. During the infusion there was an increase in sodium excretion both in absolute values and in relationship to GFR. The increase was, however, much less pronounced in the younger lambs. The GFR did not change significantly during saline infusion. The cortical blood flow increased only in the older lambs. As a consequence the quotient between GFR and cortical blood flow decreased in the older lambs. The possibility of a causal relationship between the fall in filtration fraction so obtained and the more pronounced natriuretic response in the older lambs is discussed. The inner to outer cortical blood flow ratio increased more in the younger lambs during saline infusion. The functional significance of an age related blood flow redistribution is, however, not clear.

Acute effect of prednisolone on renal handling of sodium

The effect of prednisolone on renal handling of sodium (Na) was studied in rats under three experimental conditions: 1) hydropenia, 2) water diuresis, and 3) distal tubular blockade (DTB). Prednisolone, 0.25 mg/100 g per hr, was infused directly into left renal artery and urine was collected separately from each kidney. Predominantly unilateral increases in urine flow (V) and Na excretion were noticed in all experiments during prednisolone infusion. In the hydropenic rats the maximal increments on the infused side were, for V (mean ± SD), from 9.3 ± 1.5 to 21.4 ± 0.8 μl/min (P < 0.001); for C_Na/C_In, from 0.28 ± 0.11 to 2.97 ± 0.71 % (P < 0.005); and for TH2Oc/CIn, from 2.93 ± 2.26 to 5.32 ± 1.92% (P < 0.05). In the rats with water diuresis, the maximal increases were, for V/C_In, from 5.87 ± 1.97 to 10.1 ± 6.0% (P < 0.005); for C_H2O/C_In, from 4.09 ± 0.68 to 6.00 ± 0.44% (P < 0.0005); and for C_Na/C_In, from 0.22 ± 0.07 to 0.70 ± 0.38% (P < 0.01). In DTB-rats the maximal increases were for V from 48.6 ± 9.0 to 72.7 ± 14.1 μl/min (P < 0.0005) and for C_Na/C_In from 9.42 ± 2.97 to 20.23 ± 7.34% (P < 0.005). In the contralateral kidney these changes were less pronounced. These observations suggest that prednisolone depresses directly Na reabsorption. The association of natriuresis with augmented TH2Oc/CIn and C_H2O/C_In during hydropenia and water diuresis, respectively, and the increases in V and C_Na/C_In during DTB, all are consistent with inhibition of Na reabsorption in the proximal tubule.

Evidence for hemodynamic autoregulation of renin release

To examine the relationship between renal arteriolar dilatation and renin release, arterial perfusion pressure in anesthetized dogs was lowered in steps within and below the range of autoregulation of renal blood flow. Renin release, determined by both bioassay and radioimmunoassay, averaged 2.7 ± 0.9 ( SE ) µg/min at control pressure and increased to 20.0 ± 4.1 ( SE ) µg/min at the lowest autoregulating pressure, which averaged 66.4 ± 2.9 ( SD ) mm Hg. However, renin release then remained constant during further lowering of arterial perfusion pressure despite reductions in renal blood flow. This response was not significantly changed when sodium excretion was increased by intravenous infusion of mannitol. In another series of experiments, renin release was raised by reducing arterial perfusion pressure below the range of autoregulation, and control sodium excretion was reestablished by mannitol or saline infusion; renin release remained high. Therefore, renin release appears to be related to autoregulated dilatation of the renal arterioles, and it becomes maximal when the arterioles are completely dilated at the lowest pressure of autoregulation of renal blood flow. This mechanism is different from release mechanisms dependent on sodium delivery to the distal nephron.

The effect of chronic hypotonic volume expansion on the renal regulation of acid-base equilibrium

Balance studies have been carried out to evaluate the influence of vasopressin-induced volume expansion on acid-base equilibrium in normal dogs and in dogs with steady-state metabolic acidosis induced by the administration of 5-7 mmoles/kg per day of hydrochloric acid.Hypotonic expansion in dogs with metabolic acidosis (mean plasma bicarbonate concentration 14 mEq/liter) produced a marked increase in renal acid excretion that restored plasma bicarbonate concentration to normal (20-21 mEq/liter) despite continued ingestion of acid. When water was restricted during the vasopressin period, and fluid retention thus prevented, no increase in acid excretion or plasma bicarbonate concentration occurred. From these findings we conclude that hypotonic expansion is a potent stimulus to renal hydrogen ion secretion and greatly facilitates the renal removal of an acid load. Normal dogs subjected to expansion demonstrated no change in net acid excretion or in plasma bicarbonate concentration even in the face of a marked diuresis of sodium and chloride and a reduction in plasma sodium concentration to approximately 110 mEq/liter. The animals did, however, regularly lose potassium, a finding that clearly indicates an acceleration of distal sodiumcation exchange. On the basis of these observations, and the findings in the expanded acidotic dogs, we suggest that in the expanded normal dogs acceleration of sodium-hydrogen exchange was responsible for preventing a bicarbonate diuresis and for stabilizing plasma bicarbonate concentration. These studies clearly demonstrate that chronic hypotonic expansion exerts a major influence on the renal regulation of acid-base equilibrium. The exact nature of the mechanism responsible for the increase in sodium-hydrogen exchange during hypotonic expansion remains to be determined.

Increased ureteral back pressure enhances renal tubular sodium reabsorption

Moderate increases of ureteral back pressure usually cause decreases of glomerular filtration rate and even greater decreases of sodium excretion. It has been assumed previously that increased ureteral back pressure does not enhance renal tubular sodium reabsorption directly and that the decreases of sodium excretion are caused by the decreases of glomerular filtration rate. In the experiments reported here, the effect of increased ureteral back pressure on urinary sodium excretion was studied in dogs in which changes of filtration rate were minimized by infusing saline while ureteral back-pressure was increased. When ureteral back pressure was increased on one side by 10-23 cm of water, the inulin clearance of the experimental kidney decreased by only 3-12% in 21 experiments, did not change significantly (+/-2%) in eight experiments, and increased by 3-8% in seven experiments. The sodium excretion of the experimental kidney decreased in all experiments regardless of whether its inulin clearance increased, decreased, or was unchanged from control values. When the inulin clearance of the experimental kidney increased or remained unchanged during increased ureteral back pressure, its reabsorption of sodium increased more than could be accounted for by the increase of filtered sodium. When the inulin clearance of the experimental kidney decreased during increased ureteral back pressure, its reabsorption of sodium decreased less than could be accounted for by the decrease of filtered sodium.Therefore, the effect of increased ureteral back pressure to decrease urinary sodium excretion is caused in part by increased tubular reabsorption of sodium.

Regulation of renal bicarbonate reabsorption by extracellular volume

The ability of the kidney to reabsorb bicarbonate is held to be a function of plasma CO(2) tension, carbonic anhydrase activity, and potassium stores. The effects of alterations of extracellular volume on bicarbonate reabsorption were studied in dogs whose arterial Pco(2) was kept constant at 40 mm Hg (range 35-45 mm Hg). The effect of extracellular volume expansion was studied in dogs receiving hypertonic bicarbonate and isotonic saline, isotonic saline alone (two of the animals in this group received HCl to lower the plasma bicarbonate concentration), and isotonic bicarbonate. The results were similar in each group. Extracellular volume expansion depressed bicarbonate reabsorption. This depression was related not to changes in glomerular filtration rate (GFR) or bicarbonate concentration, but to the increase of fractional sodium excretion. In addition, volume expansion with bicarbonate increased chloride excretion. Bicarbonate loading was performed in two groups of dogs in which effective expansion of extracellular volume was minimized by hemorrhage or acute constriction of the thoracic vena cava. Both groups demonstrated enhanced bicarbonate reabsorption relative to that seen in the volume-expanded groups. Release of the caval ligature promptly decreased bicarbonate reabsorption. Plasma potassium decreased in all animals studied, but the changes in bicarbonate reabsorption noted could not be related to the decrease. This study demonstrates that the state of effective extracellular volume is a major determinant of bicarbonate reabsorption by the kidney.

Natriuretic activity in plasma and urine of salt-loaded man and sheep

The present study was designed to examine the question of whether or not there is a natriuretic hormonal substance involved in the renal regulation of sodium balance. For this purpose, procedures for concentration and fractionation of plasma and urine samples and a sensitive bioassay for demonstrating changes in renal sodium excretion were developed. The natriuretic assay utilized rats with mild diabetes insipidus which were maintained in salt and water balance. Using these approaches a natriuretic humoral substance was demonstrated in plasma and urine from normal man and sheep, and in patients with primary aldosteronism or essential hypertension. It seems likely that this substance participates in day to day regulation of sodium balance because it was not detectable in sodium-depleted subjects and it consistently appeared in the sodium-loaded subjects. The hormonal agent may not act immediately and its activity can be apparent for up to 3 hr. Full expression of its activity requires that the assay animals be appropriately volume expanded. This suggests that the increases in sodium excretion mediated by this hormonal substance depend in part on the coparticipation of other physical and perhaps humoral factors. This natriuretic substance appears to be of large molecular weight or carried by a large molecule. The data suggest that it acts, at least in part, to block sodium reabsorption in a more distal portion of the tubule.