The incidence and prevalence of obesity and the metabolic syndrome have risen markedly in the past decade, representing a serious cardiovascular health hazard with significant morbidity and mortality. The etiology of the metabolic syndrome and its various pathogenic mechanisms are incompletely defined and under intense investigation. Contemporary research suggests that the adipocyte-derived hormone leptin may be an important factor linking obesity, the metabolic syndrome, and cardiovascular disorders. Although recent evidence indicates that under normal conditions leptin may be an important factor in regulating pressure and volume, during situations of chronic hyperleptinemia and leptin resistance, this hormone may function pathophysiologically for the development of hypertension and cardiac and renal diseases. Future research will determine if reduction of circulating leptin and/or blockade of its peripheral actions can confer cardiovascular and renal protection in hyperleptinemic patients with obesity and the metabolic syndrome.

The hemodynamic, hormonal, and renal excretory effects of intravenous bolus administration of synthetic murine leptin were examined in groups of anesthetized normotensive (Sprague-Dawley), hypertensive (spontaneously hypertensive), and both lean and obese Zucker rats. In the normotensive animals ( n = 8) an intravenous bolus of 400 μg/kg of leptin produced a significant six- to sevenfold elevation in sodium excretion compared with controls ( n = 8). The onset of natriuresis was delayed for ∼30–45 min. Mean arterial pressure (MAP), creatinine clearance, plasma renin activity (PRA), and plasma aldosterone concentration (PAC) remained unchanged. In contrast, the hypertensive rats were refractory to the natriuretic effects of leptin when infused either with 400 ( n = 8) or 1,600 ( n = 8) μg/kg. Also in these animals MAP, creatinine clearance, PRA, and PAC were unmodified. Finally, whereas lean Zucker rats ( n = 8) responded very similarly to the Sprague-Dawley animals, the natriuretic effect of the hormone was attenuated in the obese Zucker groups. At 400 μg/kg ( n = 8) no natriuresis was elicited, but at 1,600 μg/kg ( n = 8) a modest but significant two- to threefold increment in sodium excretion was observed in the obese rats. In both Zucker groups, MAP, creatinine clearance, PRA, and PAC were unchanged. Collectively, these results demonstrate a significant natriuretic effect of exogenous leptin in the normal rat and a blunted saluretic response in hypertension and obesity. It is suggested that leptin may be a potential salt-excretory factor in normal rats and may function pathophysiologically in obesity and hypertension.

SUMMARY Renal function and renin release were studied in anesthetized, uninephrectomized dogs during intrarenal infusions of the calcium influx blockers, verapamil and nifedipine. Verapamil increased renal blood flow by 20% (p < 0.05) but did not alter glomerular nitration rate. Verapamil produced five-to-seven fold increases in urine flow and the rates of excretion of sodium and chloride (p < 0.01). Significant increases in the rates of excretion of potassium, calcium and magnesium were also observed. Despite its striking effects on renal function, verapamil, in nonhypotensive doses, failed to alter renin secretion. Intrarenal infusion of nifedipine had no consistent effect on renal blood flow or the rate of glomerular filtration but increased urine flow and the rates of excretion of sodium and chloride by more than three fold (p < 0.01). Nonhypotensive doses of nifedipine had no significant effect on renin release. In dogs with a denervated nonfiltering kidney, an intrarenal verapamil or nifedipine infusion did not produce a significant change in renin release. This study demonstrates a striking effect of calcium entry blockers on the reabsorption of sodium, chloride, and water by the renal tubules in intact dogs but renin release did not increase unless hypotension occurred. (Hypertension 5: 482-488, 1983) KEY WORDS • verapamil nonfiltering kidney nifedipine • renin secretion • natriuresis • diuresis A LTHOUGH renin release is controlled by several fairly well-defined mechanisms, the basic cellular processes involved in the secretion of renin from the juxtaglomerular cells are unknown. There have been attempts to relegate an important fundamental role to the calcium ion in the renin secretory process'-2 and it has been suggested 1 that the calcium ion might be part of a final common pathway for renin release. An inverse relationship for calcium and renin release has been demonstrated by use of calcium free solutions to stimulate renin release in the isolated, perfused rat kidney 3 and by increasing plasma calcium concentration to inhibit renin secretion in the intact dog. 4 -5 Recently, calcium entry blockers such as verapamil and nifedipine have been studied extensively and found to be very useful in the treatment of coronary artery disease. Presumably, verapamil and nifedipine promote vascular smooth muscle relaxation by decreasing transmembrane calcium flux and intracellular calcium concentration. Little is known about their action on the kidney and on renin release. Nifedipine has been reported to increase plasma renin activity (PRA) in patients 6 but it is unclear whether this effect was produced by a direct action on the kidney or was an indirect result of arterial hypotension.The purpose of the present study was to examine the effects of calcium entry blockers on renin release and renal function. The two structurally dissimilar calcium entry blockers, verapamil and nifedipine, were infused into the renal artery of anesthetized dogs at both nonhypotensive and hypotensive doses. Since these drugs p...

The hormonal, hemodynamic and renal excretory changes after an oral load of sodium were examined in renal-denervated dogs with an arteriovenous (AV) fistula and the syndrome of compensated high-output heart failure. After ingestion of a meal containing 125 meq of sodium, the total postprandial urinary sodium excretion and fractional sodium excretion were approximately twofold higher in the renal-denervated AV fistula dogs, compared with a control group with intact renal nerves (P < 0.05). The postprandial elevations in right atrial pressure, plasma atrial natriuretic factor, and filtered load of sodium were similar in the two groups (P > 0.05). Mean arterial pressure and plasma renin activity remained unchanged from baseline in the two subsets of animals (P > 0.05). In the renal-denervated AV fistula dogs, ingestion of a low-salt meal containing 2-3 meq of sodium produced elevations in creatinine clearance and filtered load of sodium of similar magnitude to the high-salt meal. However, the increases in sodium excretion and plasma atrial natriuretic factor were modest and inconsistent. These results demonstrate that the renal nerves play an important modulatory role for postprandial sodium metabolism after a high-salt meal in experimental compensated high-output heart failure. It is suggested that the renal nerves attenuate the expression of postprandial natriuretic mechanisms via a direct tubular mechanism of action.