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Interrelationships between sodium clearance, plasma aldosterone, plasma renin activity, renal hemodynamics and blood pressure in renal disease

Beziehungen zwischen Natriumclearance, Plasmaaldosteron, Plasmarenin, renaler Hämodynamik und Blutdruck bei Nierenkrankheiten

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Zusammenfassung

In dieser Studie wurde die Rolle von Aldosteron, glomerulärer Filtration und Blutdruck auf die Natriumausscheidung bei Nierenkrankheiten untersucht. Natrium-Clearance (CNa), Plasma-Aldosteron (PA), Plasmareninaktivität (PRA), glomeruläre Filtration (GF), Paraaminohippurat-Clearance (CPAH) und Blutdruck wurden bei 19 Nierengesunden, 38 Patienten mit benigner essentieller Hypertonie, 3 mit Nierenarterienstenose, 48 mit chronischer Glomerulonephritis, 20 mit einem nephrotischen Syndrom, 24 mit tubulo-interstitiellen Nephropathien und 21 Empfängern von Nierentransplantaten simultan bestimmt.

CNa war nur beim nephrotischen Syndrom erniedrigt. PA und PRA waren nur bei Nierenarterienstenose im Druchschnitt erhöht. CNa korrelierte umgekehrt mit PA in allen Gruppen, mit Ausnahme der tubulo-interstitiellen Nephropathien. CNa wies eine direkte Korrelation mit GF beim nephrotischen Syndrom und mit dem Blutdruck bei chronischen Nephritiden auf. PA verhielt sich parallel zu PRA und korrelierte umgekehrt mit GF und CPAH in den meisten Gruppen.

Somit ist PA ein wichtiger Faktor für die Regulation der basalen Natriumausscheidung bei Nierenkrankheiten, mit Ausnahme der tubulo-interstitiellen Affektionen. Beim nephrotischen Syndrom wird die Natriumausscheidung sowohl von GF als auch von PA beeinflußt. Bei chronischen Nephropathien, jedoch nicht bei der essentiellen Hypertonie, ist die tubuläre Natriumrückresorption z.T. blutdruckabhängig. Bei reduzierter Nierenfunktion nimmt PA häufig zu.

Summary

This study was designed to evaluate the role of aldosterone, glomerular filtration and blood pressure on sodium excretion in renal disease. Sodium clearance (CNa), plasma aldosterone (PA), plasma renin activity (PRA), glomerular filtration rate (GF), paraaminohippurate clearance (CPAH) and blood pressure were measured simultaneously in 19 normal subjects, 38 patients with benign essential hypertension, 3 with renal artery stenosis, 48 with chronic glomerulonephritis, 20 with the nephrotic syndrome, 24 with tubulo-interstitial disease and 21 with a renal homograft.

CNa was significantly depressed in patients with the nephrotic syndrome. Mean PA and PRA were increased in renal artery stenosis, but within the normal range in the other groups. CNa correlated inversely with PA in all groups but one (tubulo-interstitial disease). CNa correlated directly with GF in the nephrotic syndrome and with the mean blood pressure (mBP) in chronic glomerulonephritis and tubulointerstitial disease. PA correlated directly with PRA and inversely with GF or CPAH in most groups.

It is concluded that PA is an important determinant of the basal natriuresis in renal disease with the exception of tubulo-interstitial nephropathies. In the nephrotic syndrome sodium retention is largely determined by the interaction of PA and GF. In chronic nephropathies, but not in benign essential hypertension, the fractional sodium excretion is partly blood pressure-dependent. Impairment of renal function is often accompanied by a rise in PA.

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  1. Medizinische Poliklinik, University of Berne, Berne, Switzerland

    F. C. Reubi, P. Weidmann & Z. Glück

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Reubi, F.C., Weidmann, P. & Glück, Z. Interrelationships between sodium clearance, plasma aldosterone, plasma renin activity, renal hemodynamics and blood pressure in renal disease. Klin Wochenschr 57, 1273–1285 (1979). https://doi.org/10.1007/BF01492983

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