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(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

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