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Hypertensive patients were classified according to their plasma renin response when challenged by the potent diuretics, ethacrynic acid (50 mg IV), or furosemide (40 mg IV), into renin-unresponsive and renin-responsive groups. In the latter plasma renin activity rose by at least 0.5 ng of angiotensin/ml/hr after the diuretic. The response to volume expansion with 2 L of isotonic saline infused over 60 min was then studied. Peak rate of sodium excretion after saline loading was 994 + 186 yLEq/min in the renin-unresponsive group and peak urine flow was 11.9 + 2.1 ml/min. In the renin-responsive hypertensives peak sodium excretion was 448 + 149 ,uEq/min and peak uline flow was 5.4 1.5 ml/min. Both the sodium excretion and urine flow responses were significantly higher (P < 0.05) in the renin-unresponsive group. The degree of saline-induced diuresis and natriuresis was not related to the preexisting level of aldosterone production. Plasma renin changed little in either group during saline infusion but tended to be higher at all times in the renin-responsive subjects. The enhanced capacity of the renin-unresponsive hypertensive subjects to excrete a salt load suggests either a functionally significant degree of extracellular fluid volume expansion or a direct role for renin in the natriuresis accompanying volume expansion. Additional Indexing Words:Ethacrynic acid Furosemide Mineralocorticoid "escape" Juxtaglomerular apparatus Aldosteronism Suppressed renin Mineralocorticoid Volume expansion HYPERTENSIVE patients have an enhanced diuresis of sodium and chloride when extracellular fluid volume expansion is produced.'1' The factors controlling this alteration in the renal handling of salt and water have not been clearly identified. Correlation of saline diuresis with the level of blood

SUMMARY An unusual association of uncommon facies including telangiectasia in a butterfly distribution, a similar skin lesion on extensor areas, sparse hair, and membranoproliferative glomerulonephritis is described in a 4 year old boy and his father. The mode of inheritance of these features seems to be autosomal dominant.A family is described in which the father and his only son have an unusual association of anomalies. These comprise facial telangiectasia in a pattern not described in other syndromes; telangiectasia of some extensor surfaces; sparse hair, eyebrows, and eyelashes; and membranoproliferative glomerulonephritis. These features seem to be inherited in an autosomal dominant fashion, and after an exhaustive search we can find no evidence that this association has been previously described. Case reportA 4 year old boy admitted for tonsillectomy and adenoidectomy was found on routine urine testing to have mild proteinuria and microscopic haematuria. There had been no frank haematuria but on two occasions his urine had been pink. He had no dysuria. Two months previously he had had several undiagnosed febrile illnesses. An audiogram performed four months earlier was normal.He was born at term by caesarean section following a normal pregnancy, and weighed 3200 g. A pyloromyotomy had been performed for pyloric

Mean (SD) sublingual temperatures (°C) before, immediately after, and one hour after exercise in 10 healthy men given placebo or naloxonefive minutes before exercise The pharmacokinetics of a single oral dose of dihydrocodeine were studied in nine patients with chronic renal failure treated by haemodialysis and nine subjects with normal renal function. In the patients the mean peak plasma dihydrocodeine concentration occurred later and the area under the curve was greater than in the normal subjects. Furthermore, the drug was still detectable after 24 hours in all the patients but only three of the normal subjects. These data, together with those obtained from previously published clinical case reports, contradict the traditional view that the body's ability to cope with opioid drugs is not altered in renal failure.

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Eight patients with treated Addison's disease were studied whilst receiving different doses of fludrocortisone together with a constant intake of glucocorticoid. Plasma renin activity (PRA), blood pressure, pulse rate and plasma potassium and urea concentrations were measured after 2-week periods on each dose. In two patients, PRA measurements indicated that mineralocorticoid replacement therapy had been inadequate. In four others, PRA remained normal throughout the study, even after fludrocortisone had been discontinued, suggesting that the drug was unnecessary for the maintenance of normal sodium balance in these patients. Asymptomatic fludrocortisone overdosage was indicated by a low plasma potassium concentration, but not by PRA measurements which failed in this study to distinguish between adequate and excessive mineralocorticoid replacement.

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made in groups with differing severities of illness or temperatures intergroup comparisons of the means of the logarithmic values were made by Student's unpaired t test. Case 4 was excluded from statistical analyses involving gastrin concentrations.