Mechanism of exaggerated natriuresis in hypertensive man: impaired sodium transport in the loop of henle

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Abstract

To evaluate the effects of saline loading on distal sodium reabsorption in hypertensive man, studies were performed during both water deprivation and water diuresis in eight hypertensive subjects, and the results were compared to data obtained from similar studies in normal subjects. All hypertensive patients exhibited an enhanced excretion of filtered sodium (CNa/CIn) at any level of distal delivery of sodium compared to normal controls. Free water reabsorption (TcH2O) during hypertonic saline loading was quantitatively abnormal in the hypertensives at high levels of osmolar clearance (COsm), and also the curve of TcH2O vs. COsm leveled off above a COsm of 18 ml/min per 1.73 m2 in the hypertensive group in contrast to the normal controls in whom TcH2O showed no evidence of achieving an upper limit. Sodium depletion exaggerated the abnormality in TcH2O in hypertensives, and resulted in a positive free water clearance (CH2O) during hydropenia.

Authors

Vardaman M. Buckalew Jr., Jules B. Puschett, James E. Kintzel, Martin Goldberg