The Effect of Application of Tourniquets to the Legs on Cardiac Output and Renal Function in Normal Human Subjects 12

Fitzhugh, Francis W.; McWhorter, Robert L.; Estes, E. Harvey; Warren, James V.; Merrill, Arthur J.

doi:10.1172/jci102840

Cited by 37 publications

(6 citation statements)

References 11 publications

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“…Hyperfiltration was greater with PTH infusion; yet the latter produced relatively little effect on sodium excretion, whereas ECF expansion initiated a substantial reduction in fractional sodium reabsorption. Two other patients were studied during both volume expansion and PTH infusion and the results are included in Tables I and II.2 We believe that the foregoing data are consistent with the view that a factor (or factors) 1 These results are similar to those recently reported by Lindheimer, Lalone, and Levinsky in dogs in which GFR was increased without expanding ECF volume (6). 2 Data from three patients in whom both studies were performed are designated as Experiments 3, 4, and 6 in Table I, and as Patients 3, 7, and 8 in Table II. other than changes in filtration rate and mineralocorticoid hormone activity participated in the modulation of sodium excretion in the uremic patients.…”

Section: Control System For Sodium Excretion In Uremic Mansupporting

confidence: 76%

“…In several patients, after completion of the latter periods, the saline infusion was continued and an edema-forming stimulus was induced. This consisted of the application of tourniquets to both thighs at subdiastolic pressures (1). After an equilibration period of 20-30 min, two additional clearance periods were obtained with the cuffs inflated.…”

Section: Introductionmentioning

confidence: 99%

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Studies on the characteristics of the control system governing sodium excretion in uremic man

Slatopolsky¹,

I²,

Weerts³

et al. 1968

J. Clin. Invest.

106

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A B S T R A C T Sodium excretion was studied in a group of patients with chronic renal disease, (a) on constant salt intakes of varying amounts with and without mineralocorticoid hormone adminwitration and, (b) after acute extracellular fluid volume expansion. The lower the steady-state glomerular filtration rate (GFR), the greater was the fraction of filtered sodium excreted on both a 3.5 and 7.0 g salt diet; and the lower the GFR, the greater was the change in fractional excretion in the transition from the 3.5 to the 7.0 g salt diet. This regulatory capacity did not appear to be influenced by mineralocorticoid hormone administration. After acute expansion of extracellular fluid (ECF) volume, the increment in sodium excretion exceeded the concomitant increment in filtered sodium in six of nine studies and in the remaining three studies, the increment in excretion averaged 59% of the A filtered load (i.e., only 41%b of the increase in filtered sodium was reabsorbed). During saline loading, the decrease in fractional reabsorption of sodium tended to vary inversely with the steady-state GFR, although all patients received approximately the same loading volume.When an edema-forming stimulus was applied during saline infusion, the natriuretic response was aborted and the lag time was relatively short. When GFR and the filtered load of sodium were increased without volume expansion, the A sodium excretion averaged only 19% of the A filtered load; moreover, changes in fractional sodium reabsorption were considerably smaller than those observed during saline loading. The data implicate the presence of a factor other than GFR and mineralocorticoid changes in the modulation of sodium excretion in uremic man. INTRODUCTIONIt is unusual for a patient with chronically progressive renal disease either to accumulate edema or to sustain net sodium loss on an average salt intake. If this clinical observation reflects a continuing ability to maintain external sodium balance in the face of a diminishing number of functioning nephrons, sodium excretion/nephron must increase with time. Moreover, if external sodium balance is maintained on an unrestricted salt intake, the range over which sodium excretion varies in single nephrons must increase progressively as the nephron population decreases if ordinary dayto-day variations in salt intake are to be accommodated. Thus, to effect a change in total sodium excretion of any given magnitude, the average change in excretion per nephron must vary inversely with the number of nephrons. If this requirement for exaggerated changes in sodium excretion (per nephron) is fulfilled in chronic renal disease, an unusual opportunity might exist to distinguish tubular from glomerular contributions to the regulation of sodium excretion.In the present study some aspects of the control of sodium excretion have been studied in uremic patients.

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Section: Control System For Sodium Excretion In Uremic Mansupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Studies on the characteristics of the control system governing sodium excretion in uremic man

Slatopolsky¹,

I²,

Weerts³

et al. 1968

J. Clin. Invest.

106

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“…The degree of change was less marked if the venal caval congestion was produced below the level of the renal veins than if it was created above that level. Other investigators, by applying tourniquets to the thighs at subdiastolic pressures to cause femoral venous compression, produced comparable changes in the excretion of sodium and water (9,10).…”

Section: Discussionmentioning

confidence: 91%

The Effect of the Supine Position on Renal Function in the Near-Term Pregnant Woman12

Pritchard¹,

Barnes²,

Bright³

1955

J. Clin. Invest.

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It has been demonstrated previously that urine flow in the recumbent near-term pregnant woman is appreciably less when she is lying on her back than when she is lying on her side and that without change of position the relative oliguria persists for several hours before it is overcome (1, 2).The present report extends the observations on the effect of position on urine flow to include studies of sodium and potassium excretion, effective renal plasma flow, and glomerular filtration rate in near-term normal pregnant women, in women with eclamptogenic toxemia of pregnancy, and in women with large abdominal neoplasms originating in the pelvis. Attempts have been made to determine the mechanism by which the various observed changes in renal function are produced. METHODSStudies were made 11 times in 10 near-term normally pregnant women and 13 times in 8 women with preeclampsia. In most of these studies the excretion of sodium and potassium, the effective renal plasma flow (RPF) and the glomerular filtration rate (GFR) were measured. In one normal and one preeclamptic pregnant woman the observations were repeated following the insertion of large-bore heavy-walled ureteral catheters into both ureters well above the level of the pelvic brim. Similar renal function studies were made in two women who had large abdominal neoplasms arising from the pelvis, one an ovarian serous cystadenocarcinoma and the other a uterus containing multiple fibromyomas. Both tumors were approximately the size of a uterus at 32 to 34 weeks' gestation. Seven patients who had either delivered 7 or 8 days previously or who had undergone total hysterectomy 9 or 10 days before were also observed. Three subjects of this group had been studied previously while pregnant.All medications were stopped the night before; 2 hours before starting the study, a breakfast of milk, cereal, and 'This study was assisted by a grant from the Cleveland Area Heart Society. toast was allowed. One-half hour later an indwelling catheter was inserted into the bladder and oral hydration consisting of 100 ml. of water every 20 minutes was initiated. At this time in the 17 studies where effective renal plasma flow and inulin clearances were to be measured sodium paraminohippurate and inulin were given intravenously in suitable priming doses, followed by a sustaining infusion of each administered intravenously at a constant rate of 4 to 5 ml. per minute. Urine was collected in periods averaging 20 minutes each. With each collection the bladder was washed with distilled water followed by air. In 14 of the studies only the clearances of endogenous creatinine were determined.Paraminohippurate was measured by the method of Bratton and Marshall (3), inulin by the method of Higashi and Peters (4), and creatinine by the method of Bonsnes and Taussky (5). Sodium and potassium were determined with the Beckman flame photometer.Usually the initial observations were made in the lateral recumbent position. One hour after starting oral hydration and one-half hour before starting the first ...

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“…The antidiuresis that regularly follows venous congestion of the lower extremities or stationary standing has been ascribed in part to increased activity of the neurohypophysis as a result of diminished effective blood volume (8,9). Facts in favor of this interpretation are: 1) a diminished or absent response in subjects with diabetes insipidus or in hydropenic subjects with maximal ADH activity who are undergoing a mannitol diuresis (10); 2) a fall in urine flow out of proportion to the changes in electrolyte excretion and glomerular filtration (8, 9); 3) the appearance of an antidiuretic substance in the blood of normal subjects after circulatory collapse induced by motionless standing (11).…”

Section: Discussionmentioning

confidence: 99%

Studies on Alcohol Diuresis. Ii. The Evaluation of Ethyl Alcohol as an Inhibitor of the Neurohypophysis 12

Rubini¹,

Lamdin²,

Epstein³

1955

J. Clin. Invest.

130

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The Effect of Application of Tourniquets to the Legs on Cardiac Output and Renal Function in Normal Human Subjects 12

Cited by 37 publications

References 11 publications

Studies on the characteristics of the control system governing sodium excretion in uremic man

Studies on the characteristics of the control system governing sodium excretion in uremic man

The Effect of the Supine Position on Renal Function in the Near-Term Pregnant Woman12

Studies on Alcohol Diuresis. Ii. The Evaluation of Ethyl Alcohol as an Inhibitor of the Neurohypophysis 12

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