RENAL PLASMA FLOW AND SODIUM REABSORPTION AND EXCRETION IN CONGESTIVE HEART FAILURE 1

Abstract

Warren and Stead's (1) contention that dis- turbed renal function secondary to a diminished cardiac output is responsible for the following series of events-salt and water retention, in- creased blood and extracellular fluid volume, rise in venous pressure, edema-seemed to offer a rational explanation for some of the clinically observed phenomena. We therefore initiated a series of studies on patients with chronic con- gestive heart failure, using the clearance tech- niques of Smith and associates (2), in order to evaluate the relationship between the decreased sodium excretion in heart failure (3, 4) and renal blood flow, to determine the nature of the disturbance in renal function and the relationship, if any, between the altered renal dynamics and so- dium retention. We later attempted to define some of the variables involved in the tubular trans- fer system for sodium as it obtains in the normal and in the cardiac patient. Since our studies be- gan, Merrill (5) reported that the renal plasma flow was reduced to as little as 20 per cent and the filtration rate to 33 per cent of normal in chronic