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28. Paradoxes of body fluid volume regulation in health and disease. A unifying hypothesis

Author

Schrier, R W and Niederberger, M

Subjects
Heart Failure, Liver Cirrhosis, Body Water, Pregnancy, Sodium, Homeostasis, Humans, Female, Kidney, Research Article, Body Fluids
Abstract

The body's normal homeostasis is maintained by the integrity of the excretory capacity of the kidneys. In advanced cardiac failure, however, the avidity of the renal sodium and water retention contributes to the occurrence of pulmonary congestion and peripheral edema. In patients with advanced cirrhosis, the kidneys again fail to excrete the amounts of sodium and water ingested, thus leading to ascites and peripheral edema. The signals for this renal retention of sodium and water in a patient with cirrhosis must be extrarenal because when the same kidneys are transplanted into persons with normal liver function, renal sodium and water retention no longer occurs; rather, the kidneys maintain normal fluid and electrolyte balance. Excessive sodium and water retention by the kidneys also occurs during pregnancy despite a 30% to 50% increase in plasma volume, cardiac output, and glomerular filtration rate. What are the afferent and efferent signals whereby normal kidneys retain sodium and water so that total extracellular, interstitial, and intravascular volumes expand far beyond those limits observed in normal subjects? These dilemmas are the subject of this review, in which a "unifying hypothesis of body fluid volume regulation" is presented.

Published
1994

32. Role of distal reabsorption and peritubular environment in glomerulotubular balance.

Author

Schrier, R. W and Humphreys, M. H

Subjects
Biosciences
Abstract

Total kidney glomerulotubular balance was examined during aortic constriction and release in saline-loaded dogs and in dogs undergoing water diuresis. Aortic constriction lowered the glomerular filtration rate by 45% in both groups, and glomerulotubular balance, as judged by changes in absolute sodium reabsorption, was also comparable. During water diuresis, a linear relationship was observed between free water clearance and urine flow during all maneuvers, suggesting that distal sodium reabsorption is related primarily to distal delivery. The results suggest that if alterations in the peritubular environment are responsible for the changes in tubular sodium reabsorption during aortic constriction in the saline- or water-loaded dog, then a change in renal plasma flow, and presumably delivery rate of oncotic force, may be the most likely mediator.

Published
1972

33. Role of cardiac output and the autonomic nervous system in the antinatriuretic response to acute constriction of the thoracic superior vena cava.

Author

Schrier, R. W, Humphreys, M. H, and Ufferman, R. C

Subjects
Biosciences
Abstract

Study of the differential characteristics of hepatic congestion and decreased cardiac output in terms of potential afferent stimuli in the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction. An attempt is made to see if the autonomic nervous system is involved in the antinatriuretic effect of acute TIVC or thoracic superior vena cava constriction.

Published
1971

34. Factors involved in the antinatriuretic effects of acute constriction of the thoracic and abdominal inferior vena cava.

Author

Schrier, R. W and Humphreys, M. H

Subjects
Biosciences
Abstract

Study of the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction in the absence of alterations in renal perfusion pressure. A comparison is made of the effects of equivalent degrees of TIVC and abdominal inferior vena cava constriction on arterial pressure, renal hemodynamics, and electrolyte excretion.

Published
1971

41. Sepsis and Acute Renal Failure.

Author

Vincent, Jean-Louis, Schrier, R. W., Zolty, E., and Wang, W.

Abstract

Severe sepsis is associated with acute renal failure in approximately 23% of patients, while septic shock is complicated by acute renal failure in 51% of patients [1]. Acute renal failure associated with sepsis has a mortality as high as 70-80% [2]. Much of the hemodynamic and inflammatory events which accompany sepsis are related to endotoxemia. The study of the renal effects of endotoxemia have, therefore, provided substantial insights into the mechanisms mediating acute renal injury during sepsis. [ABSTRACT FROM AUTHOR]

Published
2006
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