Clinical Investigation

Kidney International (1972) 1, 55–64; doi:10.1038/ki.1972.8

Renal concentrating ability in cirrhosis III. Failure of hypertonic saline to increase reduced TcH2O formation

Carlos A Vaamonde, Jorge I Presser, Liliana S Vaamonde and Solomon Papper

Department of Medicine, University of Miami School of Medicine and the Medical Service, Veterans Administration Hospital, Miami, Florida, and the University of New Mexico School of Medicine, the Bernalillo County Medical Center and the Veterans Administration Hospital, Albuquerque, New Mexico

Correspondence: Dr Carlos A Vaamonde, Medical Service, Veterans Administration Hospital, Miami, Florida, 33125, U.S.A.

Received 9 July 1971; Revised 18 August 1971.

Top

Abstract

Renal concentrating ability in cirrhosis. III. Failure of hypertonic saline to increase reduced TcH2O formation. The present study examines the possibility that the solute-free water reabsorption (TcH2O) defect observed in some patients with cirrhosis of the liver may be due to decreased distal delivery of sodium. TcH2O was studied in cirrhotics with low TcH2O formation and in non-cirrhotic controls undergoing mannitol and saline diuresis on different days while receiving a low sodium intake. Despite a three-fold increase in urinary sodium excretion and an increase in serum sodium concentration with hypertonic saline, TcH2O formation was not improved or corrected in the cirrhotic patients and was always lower per unit of solute excretion than that observed in controls with comparable sodium excretion. The exact mechanism of the concentrating defect remains unknown but the data suggest that the TcH2O defect is not related to a decreased delivery of sodium to the distal nephron consequent to increased proximal reabsorption or to a lower tubular fluid concentration of sodium at the distal concentration site.

Abilité de concentration du rein dans la cirrhose. III. Inabilité du salin hypertonique à augmenter la formation réduite de TcH2O. Le présent travail examine la possibilité que le défaut de réabsorption de l'eau libre (TcH2O) observé chez certains patients porteurs de cirrhose hépatique puisse être dû à une diminution de la charge sodée distale. La TcH2O a été étudiée chez des cirrhotiques dont la formation de TcH2O était basse et chez des témoins non cirrhotiques, soit sous diurèse au mannitol ou diurèse salée à des jours différents. En dépit d'une augmentation marquée de la charge sodique distale sous perfusion salée mise en évidence par une excrétion sodique trois fois plus élevée que celle qui fut observée sous diurèse au mannitol, la formation de TcH2O ne fut ni améliorée ni corrigée et demeurait toujours plus basse par unité d'excrétion de solute que celle observée chez des témoins avec une excrétion de sodium comparable. Ces résultats suggèrent que le défaut de formation de TcH2O n'est pas relié à une diminution de la charge sodée présentée au néphron distal, conséquence d'une réabsorption proximale augmentée non plus qu'à une concentration en sodium plus basse du liquide tubulaire au site distal de concentration.

Top

References

  1. Vaamonde, C. A., Vaamonde, L. S., Morosi, H. J., Klingler, E. L., Jr., and Papper, S.: Renal concentrating ability in cirrhosis. I. Changes associated with the clinical status and course of the disease. J. Lab. Clin. Med. 70: 179–194, 1967.
  2. Vaamonde, C. A., Vaamonde, L. S., Presser, J. I., Morosi, H. J., Klingier, E. L., Jr., and Papper, S.: Role of Vasopressin and urea in the renal concentrating defect of patients with cirrhosis of the liver. Clin. Sci., 41: 441–452, 1971.
  3. Nelson, W. P., III, and Welt, L.G.: The effect of pitressin on the metabolism and excretion of water and electrolytes in normal subjects and patients with cirrhosis and ascites. J. Clin. Invest. 31: 392–400, 1952.
  4. Schedl, H. P., and Bartter, F. C.: An explanation for and experimental correction of the abnormal water diuresis in cirrhosis. J. Clin. Invest. 39: 248–261, 1960. | PubMed | ChemPort |
  5. Stein, R. M., Levitt, B. H., Goldstein, M. H., Porush, J. G., and Levitt, M. F.: The effects of salt restriction on renal concentrating operation in normal, hydropenic man. J. Clin. Invest. 41: 2102–2111, 1962.
  6. Papper, S.: The role of the kidney in Laennec's cirrhosis of the liver. Medicine 37: 299–316, 1958.
  7. Cirksena, W. J., Dirks, J. H., and Berliner, R. W.: Effect of thoracic cava obstruction on response of proximal tubule sodium reabsorption to saline infusion. J. Clin. Invest. 45: 179–186, 1966.
  8. Kaloyanides, G. J., Cacciaguida, R. J., Pablo, N. C., and Porush, J. G.: Increased sodium reabsorption in the proximal and distal tubule of caval dogs. J. Clin. Invest. 48: 1543–1551, 1969.
  9. Porush, J. G., Goldstein, M. H., Eisner, G. M., and Levitt, M. F.: Effect of organomercurials on the renal concentrating operation in hydropenic man: Comments on site of action. J. Clin. Invest. 40: 1475–1485, 1961.
  10. Goldberg, M., McCurdy, D. K., and Ramirez, M. A.: Differences between saline and mannitol diuresis in hydropenic man. J. Clin. Invest. 44: 182–192, 1965.
  11. Lassiter, W. E., Mylle, M., and Gottschalk, C. W.: Net transtubular movement of water and urea in saline diuresis. Am. J. Physiol. 206: 669–673, 1964.
  12. Giebisch, G., Klose, R. M., and Windhager, E. E.: Micropuncture study of hypertonic sodium chloride loading in the rat. Am. J. Physiol. 206: 687–693, 1964.
  13. Snedecor, G. W., and Cochran, W. G.: Statistical Methods, 6th ed., Ames, Iowa State University Press, 1967.
  14. Porush, J. G., Cacciaguida, R. J., Pablo, N. C., Basilio, R. D., Kaloyanides, G. J., and Salman, K. H.: Urinary concentrating operation in caval dogs. Am. J. Physiol. 220: 1547–1552, 1971.
  15. Vaamonde, C. A., Vaamonde, L. S., Morosi, H. J., Klingler, E. L., Jr., and Papper, S.: Renal concentrating ability in cirrhosis of the liver. Clin. Res. 13: 316, 1965.
  16. Auld, R. B., Alexander, E. A., and Levinsky, N. G.: Proximal tubular function in dogs with thoracic caval constriction. Abstracts of Am. Soc. Nephrol. 3: 3, 1969.
  17. Levy, M.: Proximal and distal tubular function in chronic caval dogs. Clin. Res., 18: 507, 1970.
  18. Barger, A. C.: Renal hemodynamic factors in congestive heart failure. Ann. N.Y. Acad. Sci. 139: 276–284, 1966. | PubMed | ChemPort |
  19. Hollenberg, N. K., Epstein, M., Guttmann, R. D., Conroy, M., Basch, R. I., and Merrill, J. P.: Effect of sodium balance on intrarenal distribution of blood flow in normal man. J. Appl. Physiol. 28: 312–317, 1970. | PubMed | ISI | ChemPort |
  20. Horster, M., and Thurau, K.: Micropuncture studies of the filtration rate of single superficial and juxtamedullary glomeruli in the rat kidney. Pflügers Arch. ges. Physiol. 301: 162–181, 1968.
  21. Jamison, R. L.: Effect of saline infusion on filtration rate and sodium reabsorption in single superficial and juxtamedullary nephrons. J. Clin. Invest. 49: 48a, 1970.
  22. Blantz, R. C., Katz, M. A., Rector, F. C., Jr., and Seldin, D. W.: Measurement of intrarenal blood flow. II. Effect of saline diuresis in the dog. Am. J. Physiol. 220: 1914–1920, 1971.
  23. Mandin, H., Israelit, A. H., Rector, F. C., Jr., and Seldin, D. W.: Effect of saline infusions on intrarenal distribution of glomerular filtrate and proximal reabsorption in the dog. J. Clin. Invest. 50: 514–522, 1971.
  24. Gottschalk, C. W., Mylle, M., Jones, N. F., Winters, R. W., and Welt, L. G.: Osmolality of renal tubular fluids in potassium depleted rodents. Clin. Sci. 29: 249–260, 1965.
  25. Jones, N. F., Mylle, M., and Gottschalk, C. W.: Renal tubular microinjection studies in normal and potassium depleted rats. Clin. Sci. 29: 261–275, 1965.
  26. Clapp, J. R., and Robinson, R. R.: Osmolality of distal tubular fluid in the dog. J. Clin. Invest. 45: 1847–1853, 1966.

Extra navigation

.
ADVERTISEMENT