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Portal hypertension is caused by an increased resistance to portal outflow and an increased portal blood inflow. Portal hypertension is associated with an abnormal distribution of the blood volume, which is increased in the splanchnic territory and reduced in the non-splanchnic compartments. The relative underfilling of the arterial circulation is responsible for the sodium and water retention, which is a consequence of the baroceptor-mediated activation of vasoconstrictor and antinatriuretic factors triggered to restore circulatory integrity.

The cortical distal nephron is the site of fine regulation of salt and water excretion by peptide and mineralocorticoid hormones and the site for specific actions of diuretics. Some data suggest that sodium reabsorption and potassium secretion in the distal convoluted tubule and the connecting tubule (CNT) are sufficient to maintain the sodium and potassium balance, with little or no contribution of the collecting duct. The homeostatic role of the sodium and potassium transport systems in the collecting duct can be questioned, especially in conditions where dietary sodium intake is high and potassium intake is low compared with the physiological needs of the organism. The functional expression of epithelial sodium channels (ENaC) in the CNT is sufficient for furosemide-stimulated urinary acidification and identifies the CNT as a major segment in electrogenic urinary acidification. In the outer renal cortex, the CNT returns to the glomerular hilus and contacts the renal afferent arterioles (Af-Art). This morphology is compatible with a cross-talk between the CNT and Af-Art. This novel regulatory mechanism of the renal microcirculation may participate in the vasodilatation observed during high salt intake, perhaps by antagonizing tubuloglomerular feedback. In conclusion, the cortical distal nephron appears to be a complex site for several physiological mechanisms; it is mainly involved in salt and fluid homeostasis and in acid-base balance maintenance. Furthermore, the CNT segment appears to promote a CNT-Af-Art feedback loop.

It has been examined the influence of vanadium on the papillary osmotic water-salts uptake in order to differentiate it from water flow of other biological substrates as amphibia epithelia. Between the different vanadium compounds only the metavanadate is active and only after administration in the abdominal vein. The general influence of metavanadate is a facilitating one and concerns: electrical receptor afferent discharge, osmotic water uptake and ciliary motility. At the papillary level therefore vanadium is not at all an inhibitory agent as observed in many biological substrates. This observation rule out any analogy in the processes of water inflow operating respectively at the fungiform papillae and amphibia epithelia.

Water loading was used as a diagnostic test in the study of renal excretion of water and sodium during the clinical stages of cirrhosis of the liver in 25 patients free from clinical and instrumental signs of ascites, 26 with treatable ascites, and 14 with intractable ascites. The water load consisted of 20 cc/kg water administered i.v. as a 5% glucose solution. Examination of diuresis in the ensuring 5 hr showed that: 1) clearance of free water is the most sensitive parameter for the detection of patients at short-term risk for the onset of ascites; 2) very low urinary sodium is an indicator of refractory ascites, whereas values are virtually the same and higher in subjects without ascites or with treatable forms; 3) chloruresis in only reduced significantly in cirrhosis with refractory ascites.

In the research it has been tested the ability of convoluted capillary network of the fungiform papillae to act as countercurrent ionic exchanger and therefore to give rise a water uptake from the external environment. Manometric determinations of the water inflow during immersion of the tongue in solutions of different osmolality have shown a conspicuous water uptake, osmotic in nature and largely supported by the Na+ absorbed from the external solutions. The Na+ inhibits also the receptor electrical response to the stimulating Ca++ solutions. These observations show that the papillae can be considered as osmotic devices and emphasise also that the Na+ is directly involved in the papillary functional activity.

In 25 patients with essential hypertension and 9 control subjects we have studied the effects of central hypervolemia during water immersion on both renin-angiotensin-aldosterone system and renal function (diuresis volume and urine excretion of Na, k and osmoles). Reduction of blood pressure, plasma renin activity and aldosterone was found to be similar in both groups; renal excretion of water, Na, K and osmoles was significantly higher in the hypertensive group compared to the controls. These urinary features may be related to a reduced proximal tubular reabsorption by cardiorenal reflex due to cardiopulmonary volume receptors stimulation without any change of GFR measured as the creatinine clearance. The urinary pattern, observed during water immersion in hypertensive group without any change of plasma sodium, osmolality or protein concentration, was comparable to "exaggerated natriuresis"; this may suggest that also "exaggerated natriuresis" is due either to renal vasodilatation or to renal tubular sympathetic activity reduction secondary to a cardiorenal reflex by cardiopulmonary volume expansion.

In the research it has been carried out a morphological investigation of the paracoronal area of the fungiform papillae. By means of scanning, transmission and light microscopy it has been observed in this area a series of superficial openings around and external to the ciliary crown; and in the epithelium corresponding cavitary system. Each cavity on the other hand appears surrounded by extremely narrow epithelial cells and thus appears able to facilitate the papillary exchange activity. This paracoronal cavitary system is proposed as morphological candidate for the conspicuous water entry in the papillae during osmotic phenomena.

The short-term tolerability of two types of end-to-end jejuno-ileal bypasses with different distal ileal loop lengths was evaluated. A comparison was made for 20 days of the behaviour of the main parameters influenced by the malabsorption syndrome thus induced. It was found that the operation involving a greater loss of small intestine was burdened with a greater number of discharges per day, an increase in total water loss, and an elevatem operative risk. This was compensated by more rapid and more evident loss of weight. Evaluation of the real meaning of the inversion of the A:G ratio observed in the short term with this type of operation was postponed to allow a longer follow-up period to run.

Results with a diffusor enzyme (thiomucasi) in the medical management of oedema in 29 subjects are presented. This substance was used on the assumption that interstitial mucopolysaccharides trap water by means of a polymerisation-depolymerisation process, so that its release necessitates rupture of chemicophysical bonds. The results point to the effectiveness of the drug and the soundness of this interpretation.