It is apparent that the kidney is the organ ultimately responsible for the salt and water retention, hence the edema formation, in congestive heart failure, but why the kidney fails to excrete these substances normally in this disease state remains to be determined. Venous congestion, and renal venous congestion in particular, has been postulated as one of the factors playing a role in the decreased electrolyte and water excretions. Recent observations in animals and man lend support to this concept.In dogs, each of the following acute procedures, designed to elevate renal or systemic venous pressure or both, has induced a decrease in the urinary excretion of electrolytes and water: partial ligation of the inferior vena cava above the renal veins (1), induced pericardial effusion (2) and partial ligation of one renal vein (3, 4), a procedure which induced the effect on the side of the increased renal venous pressure but not on the contralateral normal side. In chronic experiments, inferior vena caval congestion, including the renal veins, did not cause a sustained retention of electrolytes and water, whereas constriction of the inferior vena cava above the diaphragm, which added congestion of the liver, led to sustained edema and ascites (1, 5).In man, induced venous congestion has necessarily been of short duration. The renal excretion of electrolytes and water has been shown to decrease during quiet standing (6), during acute abdominal compression of sufficient degree to raise inferior vena caval pressure (7) with acute congestion of the extremities produced by inflating cuffs about the thighs and arms (8). The opposite effect, an increase in water and salt excretion, has been reported during venous congestion of the head of sitting subjects (9), during ace bandaging of the legs (10), and during the fall in systemic venous pressure which occurs in patients with congestive heart failure as a result of the intravenous administration of digoxin (11).These considerations suggested a study, in man, of the renal excretion of electrolytes and water in response to congestion of the venous system, so produced that the kidney could be included in, or excluded from, the congested area. Accordingly, venous congestion was produced at various levels of the inferior vena cava and in the superior vena cava by means of an inflatable balloon on an indwelling intracardiac catheter (12) and the resultant renal effects were determined. The data indicate that acute congestion of a sizable segment of either vena cava in man provokes a reduction in the urinary excretion of electrolytes and water.
METHODS AND PROCEDURESGeneral. The plan of study was to determine several renal, urinary, and cardiovascular functions before, during, and after induced vena caval congestion. Renal plasma flow and glomerular filtration rate were determined by clearance methods, using para-aminohippurate and inulin respectively. The urinary excretions of sodium, potassium, and chloride were measured in successive periods, and the concentrations of these elec...