Renal function with respect to water clearance and renal hemodynamics was studied in 15 patients with obstructive jaundice due to cholangiocarcinoma. The results were compared with those of the control normal subjects. There was no change in renal function in the patients with mild to moderate jaundice, with total serum bilirubin from 8.0 to 15.1 mg/dl. Increased urinary sodium excretion and decreased free water and negative water clearances were observed in the patients with severe jaundice with total serum bilirubin from 27.0 to 40.4 mg/dl and normal serum albumin. Renal blood flow was normal, but creatinine clearance was decreased. In severely jaundiced patients with serum bilirubin from 30.5 to 40.1 mg/dl and hypoalbuminemia urinary sodium excretion, free water clearance, negative water clearance, renal blood flow and creatinine clearance were decreased. There was salt and water retention in this group. The findings suggest that in severe jaundice there is inhibition of sodium chloride reabsorption in the thick ascending limb of Henle's loop. ADH and increased hydraulic conductivity of the collecting tubules possibly contribute to decreased free water clearance. In severely jaundiced patients with hypoalbuminemia this salt losing effect is converted to salt retention by increased proximal tubular reabsorption of sodium.
SUMMARY
Selective renal angiography was carried out in 9 patients with renal failure due to infection. Six patients had leptospirosis, two had E. coli septicemia and one had falciparum malaria. In all cases the pathological diagnosis was tubular necrosis. Evidence of cortical ischemia, characterized by distinct visualization of fine vascular distribution without veiling of the nephrographic effect, loss of the normal zone of corticomedullary distinction and poor maximum nephrographic density, was demonstrated in all cases. Proximal renal arterial constriction was shown in cases of septicemia, while in leptospirosis and malaria the proximal arterial trees appeared normal. These changes were reversible in 6 cases which were followed. In each case there was positive correlation between the creatinine clearance and nephrographic density.
The transient changes in cardiac output at the onset of mild exercise were measured in dogs trained to walk on a treadmill. Cardiac output was obtained using a krypton 85 infusion method, which permitted frequent determinations of flow. The first go sec of exercise were marked by a prompt rise and overshoot of heart rate and cardiac output, whereas increases in stroke volume occurred later after the onset of exercise, and to a lesser extent than heart rate. At rest, the right atrium was electrically driven at rates slightly faster than heart rates attained spontaneously with exercise and the studies repeated. Changes in cardiac output with exercise were similar to those in unpaced animals, but when the heart rate was fixed stroke volume increased immediately. These studies show a consistent rise in heart rate and cardiac output in the initial reaction to exercise, but when the prompt rise in heart rate was prevented by pacing from the right atrium, increases in stroke volume provided a comparable response in cardiac output. krypton 85; cardiac output; stroke volume; pacing of heart; oxygen consumption Submitted on September 23, 1964
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