This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Volpe, M. Articles by Condorelli, M. Search for Related Content PubMed PubMed Citation Articles by Volpe, M. Articles by Condorelli, M.

(Hypertension. 1997;30:168-176.)
© 1997 American Heart Association, Inc.

Articles

Intrarenal Determinants of Sodium Retention in Mild Heart Failure

Effects of Angiotensin-Converting Enzyme Inhibition

Massimo Volpe; Paola Magri; Maria A. E. Rao; Sara Cangianiello; Luca DeNicola; Alessandro F. Mele; Bruno Memoli; Iolanda Enea; Speranza Rubattu; Bruna Gigante; Bruno Trimarco; Murray Epstein; ; Mario Condorelli

From 1^a Clinica Medica (M.V., M.A.E.R., S.C., I.E., B.G., B.T., M.C.) and Cattedra di Nefrologia (P.M., L.D., B.M.), Università Federico II, Naples, Italy; Istituto Neurologico Mediterraneo NeuroMed (M.V., A.F.M., S.R.), Pozzilli, Italy; Nephrology Section (M.E.), Department of Veterans Affairs Medical Center, Miami, Fla; and Dipartimento di Medicina Sperimentale e Patologia (M.V.), Università La Sapienza, Rome, Italy.

Correspondence to Prof Massimo Volpe, MD, 1^a Clinica Medica, Federico II University, via Pansini, 5, 80131 Napoli, Italy. E-mail volpema{at}cds.unina.it

Abstract The onset and the mechanisms leading to Na⁺ retention in incipient congestive heart failure (CHF) have not been systematically investigated. To investigate renal Na⁺ handling in the early or mild stages of CHF, Na⁺ balance and renal clearances were assessed in 10 asymptomatic patients with idiopathic or ischemic dilated cardiomyopathy and mild heart failure (HF) off treatment (left ventricular ejection fraction, 29.7±2%) and in 10 matched normal subjects during a diet containing 100 mmol/d of NaCl and after 8 days of high salt intake (250 mmol/d). Six patients were studied again after 6 weeks of treatment with enalapril (5 mg/d PO). At the end of the high salt diet, in patients with mild HF the cumulative Na⁺ balance exceeded by 110 mmol that of normal subjects (F=3.86, P<.001). During high salt intake, renal plasma flow and glomerular filtration rate were similarly increased in both normal subjects and mild HF patients. In spite of comparable increases of filtered Na⁺ in the two groups, fractional excretion of Na⁺, fractional clearance of free water, and fractional excretion of K⁺ (indexes of distal delivery of Na⁺) increased in normal subjects and were reduced in patients with mild HF. During enalapril treatment, in the mild HF patients the cumulative Na⁺ balance was restored to normal; furthermore, enalapril significantly attenuated the abnormalities in the distal delivery of Na⁺. Our results indicate that a defective adaptation of Na⁺ reabsorption in the proximal nephron is associated with Na⁺ retention in response to increased salt intake in the early or mild stages of HF. These abnormalities of renal Na⁺ handling are largely reversed by enalapril.

Key Words: cardiomyopathy • kidney • natriuretic peptides • catecholamines • renin-angiotensin system

This article has been cited by other articles:

				M. Damgaard, J. P. Goetze, P. Norsk, and N. Gadsboll Altered sodium intake affects plasma concentrations of BNP but not proBNP in healthy individuals and patients with compensated heart failure Eur. Heart J., November 2, 2007; 28(22): 2726 - 2731. [Abstract] [Full Text] [PDF]

				M. Damgaard, P. Norsk, F. Gustafsson, J. K. Kanters, N. J. Christensen, P. Bie, L. Friberg, and N. Gadsboll Hemodynamic and neuroendocrine responses to changes in sodium intake in compensated heart failure Am J Physiol Regulatory Integrative Comp Physiol, May 1, 2006; 290(5): R1294 - R1301. [Abstract] [Full Text] [PDF]

				L. M. Ruilope, D. J. van Veldhuisen, E. Ritz, and T. F. Luscher Renal function: the Cinderella of cardiovascular risk profile J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1782 - 1787. [Abstract] [Full Text] [PDF]

				C Briguori, S Betocchi, F Manganelli, B Gigante, M.A Losi, Q Ciampi, R Gottilla, A Violante, C.G Tocchetti, M Volpe, et al. Determinants and clinical significance of natriuretic peptides and hypertrophic cardiomyopathy Eur. Heart J., August 1, 2001; 22(15): 1328 - 1336. [Abstract] [PDF]

				A. Gabrielsen, P. Bie, N. H. Holstein-Rathlou, N. J. Christensen, J. Warberg, H. Dige-Petersen, E. Frandsen, S. Galatius, B. Pump, V. B. Sorensen, et al. Neuroendocrine and renal effects of intravascular volume expansion in compensated heart failure Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2001; 281(2): R459 - R467. [Abstract] [Full Text] [PDF]

				R. W. Troughton, M. T. Rademaker, J. D. Powell, T. G. Yandle, E. A. Espiner, C. M. Frampton, M. G. Nicholls, and A. M. Richards Beneficial Renal and Hemodynamic Effects of Omapatrilat in Mild and Severe Heart Failure Hypertension, October 1, 2000; 36(4): 523 - 530. [Abstract] [Full Text] [PDF]

				P. Magri, M. A. E. Rao, S. Cangianiello, V. Bellizzi, R. Russo, A. F. Mele, M. Andreucci, B. Memoli, Luca De Nicola, and M. Volpe Early Impairment of Renal Hemodynamic Reserve in Patients With Asymptomatic Heart Failure Is Restored by Angiotensin II Antagonism Circulation, December 22, 1998; 98(25): 2849 - 2854. [Abstract] [Full Text] [PDF]