Studies on the Influence of the Low Sodium Cardiac Diet and the Kempner Regimen on Renal Hemo-Dynamics and Electrolyte Excretion in Hypertensive Subjects 123

Effects of Chlorothiazide on Specific Renal Functions in Hypertension

“…under treatment with the rice diet; in them infusion of salt-poor albumin did not increase filtration rate, while infusion of sodium lactate solution restored it to or towards control levels. 9 Since chlorothiazide is excreted in part by -)imoximal tubular secretion, apparently along a pathway similar to that of p-aiiminohippn- rate,1' it is not surprising that large intravenous doses depress renal extraction of paminohippurate in the dog. It is unlikely that this would account for the small decreases in plasma CpAHI in the tests done during oral administration, although it may account for the decreases observed in 2 patients after the intravenous injection.…”

Diurnal Cycle of Glomerular Filtration Rate and Sodium and Chloride Excretion During Responses to Altered Salt and Water Balance in Man*

“…In subjects with congestive heart failure or cirrhosis, in whom the excretory cycle is frequently reversed, the filtrationrate cycle is generally reversed also (25)(26)(27). Correspondingly, filtration rate is generally elevated above control values after chronic loading with saline (28) or after chronic water retention obligated by vasopressin (Pitressin tannate) injections (29,30) and is depressed in volunteer subjects or patients on low salt diets (31)(32)(33)(34)(35)(36). In subjects or patients in whom salt retention is induced by steroid (usually deoxycorticosterone) administration, filtration rate is generally increased after several days of salt accumulation and at the time that control rate of salt excretion has been regained (37)(38)(39)(40)(41).…”

The Nature of the Renal Circulatory Changes in Chronic Congestive Failure as Reflected by Renal Tubular Maximal Functions 12

“…Regardless of whether one accepts or rejects the existence of a distal tubule Tm for sodium (4), these data suggest that a moderate reduction infiltration rate without change in tubular function can result in salt and water retention. Although the renal mechanism for excreting sodium in the dog may differ from that in man (24), this pattern of renal dysfunction, per se, could furnish a simple explanation for the more complete tubular reabsorption of sodium occurring in congestive failure and other conditions in which glomerular filtration is diminished more than is tubular function (5,21,25).…”

“…Thus, the well-es'tablished decrease of glomerular filtration rate and renal blood flow in chronic congestive failure (2, 3) has been considered a result of inadequate cardiac output and secondary renal vasoconstriction, occurring without reduction in the mass of functioning tubules. Since the decrease in filtration reduces the quantity of electrolyte delivered to tubules normally adapted to handle a larger load (4,5), it has been postulated that the resulting glomerulo-tubular imbalance contributes significantly to the salt and water retention of congestive failure.…”