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Determinants of Exaggerated Natriuresis in Arterial Hypertension

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Kidney in Essential Hypertension

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 35))

Abstract

To examine influences on sodium excretion after volume expansion in normal volunteers and patients with primary and secondary forms of hypertension, we studied the natriuretic responses of 404 normal volunteers, 159 patients with essential hypertension, 98 patients with renal vascular hypertension, 33 patients with primary aldosteronism, and 38 patients with labile hypertension after a 2L infusion of normal saline. In normals, the fractional excretion of sodium (FENa) during saline infusion correlated directly with age and the increase in systolic blood pressure during infusion. FENa correlated inversely with PRA and body surface area. In essential hypertensives FENa correlated directly with blood pressure and age, and inversely with PRA and body surface area. Race also influenced the relationship in that FENa tended to be greater in black hypertensives. Labile hypertensives had a greater FENa than normals, or age-, race-, and sex-matched essential hypertensives. In labile hypertensives FENa correlated directly with norepinephrine in plasma and urine. Patients with primary aldosteronism had the greatest FENa and also had a kaliuresis with saline infusion. In fixed hypertensives the “exaggerated natriuresis” is a feature of hypertension with renin suppression. In labile hypertensives, natriuretic responses following sodium administration may be related to sympathetic tone. The “exaggerated natriuresis” appears to be influenced by various extra-renal factors in addition to elevated arterial blood pressure.

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Authors and Affiliations

  1. Nephrology Section, Department of Medicine, Indiana University Medical Center, 46223, Fesler Hall 108, 1120 South Drive, Indianapolis, IN, USA

    Friedrich C. Luft M.D.

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  1. Friedrich C. Luft M.D.
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  2. M. H. Weinberger
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Editors and Affiliations

  1. Hemodynamic Laboratory, Ochsner Clinic and Alton Ochsner Medical Foundation, 1514 Jefferson Highway, New Orleans, Louisiana, 70121, USA

    Franz H. Messerli MD (Director Associate Professor of Medicine) (Director Associate Professor of Medicine)

  2. Tulane University School of Medicine, New Orleans, Louisiana, USA

    Franz H. Messerli MD (Director Associate Professor of Medicine) (Director Associate Professor of Medicine)

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© 1984 Martinus Nijhoff Publishing, Boston/The Hague/Dordrecht/Lancaster

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Luft, F.C., Weinberger, M.H. (1984). Determinants of Exaggerated Natriuresis in Arterial Hypertension. In: Messerli, F.H. (eds) Kidney in Essential Hypertension. Developments in Cardiovascular Medicine, vol 35. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3897-0_9

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  • DOI: https://doi.org/10.1007/978-1-4613-3897-0_9

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-3899-4

  • Online ISBN: 978-1-4613-3897-0

  • eBook Packages: Springer Book Archive

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