Preservation of blood volume during edema removal in nephrotic subjects

Preservation of blood volume during edema removal in nephrotic subjects. During the gradual removal of edema with diuretics in 21 edematous patients with the nephrotic syndrome (NS) we monitored blood volume. For comparison, nine healthy subjects were studied after equilibration on diets containing 20, 200, and 1138mEq sodium. The initial extracellular fluid volume (ECFV) in the patients exceeded the final ECFV by 63.4 ± 8.4%. In 10 patients with a very low plasma oncotic pressure (8.2 ± 0.4mm Hg, Group 1), the blood volume changed little. In Group 2 (plasma oncotic pressure 13.4 ± 1.0mm Hg), it was 11.0 ± 2.5% higher at entry than after edema withdrawal. In the normal volunteers, the highest sodium intake raised the ECFV by 21.4 ± 4.1%. The accompanying rise in blood volume, 11.2 ± 3.0%, was larger than in the patients of Group 1 (2.4 ± 1.9%, P < 0.04), but not of Group 2 (8.1 ± 1.9%, NS) at similar degrees of expansion. There was no difference in blood volume between the edema-free patients and the normal subjects at low-sodium diet. The course of blood pressure and creatinine clearance during edema removal gave no evidence that functional hypovolemia was induced, but the plasma renin activity was higher than in the normal subjects at similar degrees of expansion. We conclude that the blood volume to ECFV relationship curve is flattened in the presence of hypoalbuminemia. Thus, the increase in blood volume that normally follows ECFV expansion is less in patients with the NS, but a drop below normal upon removal of edema is absent also

Functional relationships in the nephrotic syndrome

Functional relationships in the nephrotic syndrome. An analysis of 70 observations in patients with the nephrotic syndrome (NS) on a low sodium diet is presented. The following parameters were determined: plasma volume, plasma renin activity, plasma aldosterone concentration, serum albumin, urinary sodium and protein excretion, and creatinine clearance. In 41 instances glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined on the basis of 51Cr-EDTA and 125I-hippuran clearances, and the filtration fraction (FF) was calculated. The results in patients with minimal lesions (ML) and those with histological glomerular lesions (HL) were compared to determine whether these groups can be separated on the basis of signs of hypovolemia and primary renal sodium retention. Although a higher proportion of the ML patients showed extreme sodium retention and elevated plasma renin and aldosterone levels, these values tended to overlap and no differences were found for blood volume, blood pressure, and overall renal function between the groups. FF was markedly and equally depressed in both groups: 13.5 ± 1.6% in the ML and 14.2 ± 1.1% SEM in the HL group (NS). Analysis of the within-group relationships between the parameters under study revealed relatively few correlations, which supports the hypothesis that primary impairment of renal water and salt excretion is an important if not overruling factor in patients with the NS.Relations fonctionnelles au cours du syndrome néphrotique. Une analyse de 70 observations de malades atteintes de syndrome néphrotique (NS) en régime pauvre en sodium est présentée. Les paramètres suivants ont été déterminés: volume plasmatique, activité rénine plasmatique, aldostéronémie, albuminémie, natriurèse et protéinurie, et clearance de la créatinine. Dans 41 fois, le débit de filtration glomérulaire (GFR) et le débit plasmatique rénal efficace (ERPF) ont été déterminés par des clearances au 51Cr-EDTA et au 125I-hippuran, et on a calculé la fraction de filtration (FF). Les résultats des groupes de malades atteints de lésions minimes (ML) et de ceux atteints de lésions glomérulaires histologiques (HL) ont été comparés pour savoir s'il est possible de séparer ces groupes sur la base des signes d'hypovolémie et de rétention sodée d'origine rénale. Bien qu'une plus forte proportion de malades ML ait présenté une réntention sodée et une élévation des niveaux de rénine et d'aldostérone plasmatiques extrêmes, ces valeurs tendaient à se chevaucher et il n'a pas été trouvé de différence dans le volume sanguin, la pression artérielle et la fonction rénale globale entre les groupes. FF était diminuée de façon marquée et identique dans les deux groupes: 13,5 ± 1,6% dans le groupe ML et 14,2 ± 1,1% SEM dans le groupe HL (NS). Une analyse des interrelations à l'intérieur des groupes entre les paramètres étudiés a révélé relativement peu de corrélations, ce qui est en faveur de l'hypothèse que l'altération primitive de l'excrétion rénale d'eau et de sel est un facteur important, sinon capital chez les malades atteints de NS

Controversies and problems of volume control and hypertension in haemodialysis

WOS: 000379736100033PubMed ID: 27226131Extracellular volume overload and hypertension are important contributors to the high risk of cardiovascular mortality in patients undergoing haemodialysis. Hypertension is present in more than 90% of patients at the initiation of haemodialysis and persists in more than two-thirds, despite use of several antihypertensive medications. High blood pressure is a risk factor for the development of left ventricular hypertrophy, heart failure, and mortality, although there are controversies with some study findings showing poor survival with low-but not high-blood pressure. The most frequent cause of hypertension in patients undergoing haemodialysis is volume overload, which is associated with poor cardiovascular outcomes itself independent of blood pressure. Although antihypertensive medications might not be successful to control blood pressure, extracellular volume reduction by persistent ultrafiltration and dietary salt restriction can produce favourable results with good blood pressure control. More frequent or longer haemodialysis can facilitate volume and blood pressure control. However, successful volume and blood pressure control is also possible in patients undergoing conventional haemodialysis