ASSOCIATION OF HYPONATREMIA WITH INCREASED RENIN-ACTIVITY IN CHRONIC CONGESTIVE HEART-FAILURE - IMPACT OF DIURETIC THERAPY
ASSOCIATION OF HYPONATREMIA WITH INCREASED RENIN-ACTIVITY IN CHRONIC CONGESTIVE HEART-FAILURE - IMPACT OF DIURETIC THERAPY
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DOI：
10.1016/0002-9149(83)90200-x
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发表时间：
1983-01-01
影响因子：
2.8
通讯作者：
CODY, RJ
中科院分区：
文献类型：
--
作者：
SCHAER, GL;COVIT, AB;CODY, RJ
报道了严重充血性心力衰竭（CHF）患者低钠血症与血浆肾素活性（PRA）升高之间的相关性，具有临床和病理生理意义。为了确定利尿剂治疗[速尿和旋内酯]对这一关系的影响，我们对44例维持利尿剂治疗的重症CHF患者血清Na、肾氮血症（血尿素/肌酐比值[BUN/Cr]）和PRA的相关性进行了评估。血清Na水平与PRA呈负相关（r = -0.389, P < 0.02）。BUN/Cr比值与PRA呈显著相关（r = 0.365, P < 0.025），血清Na水平与BUN/Cr比值呈负相关（r = 0.332, P < 0.025）。多元回归分析显示，3个变量之间存在显著的相关性（P < 0.01）。为了评估利尿剂治疗的效果，在平衡研究中，12名严重CHF患者停止利尿剂治疗，分别接受10和100 meq Na饮食，各1周。PRA的范围为0.14-16 ng/ml / h。尽管在这个范围内，血清Na或BUN/Cr比值与PRA没有显著相关性。利尿剂治疗的CHF患者出现明显的低钠血症和肾性氮血症可能提示PRA升高。大量的患者间差异限制了这些相关性的预测值。尽管这些相关性可能有一定的临床价值，但它们不应被用来推断CHF的严重程度或CHF中水分平衡的病理生理学。
A correlation between hyponatremia and increased plasma renin activity (PRA) was reported in patients with severe congestive heart failure (CHF), implying both clinical and pathophysiologic significance. To determine the impact of diuretic therapy [furosemide and spironolactone] on this relation, the correlation of serum Na, prerenal azotemia (blood urea/creatinine ratio [BUN/Cr]) and PRA were evaluated in 44 patients with severe CHF who were maintained on diuretic therapy. Serum Na level was inversely related to PRA (r = -0.389, P < 0.02). A significant correlation existed between the BUN/Cr ratio and PRA (r = 0.365, P < 0.025) and an inverse correlation between serum Na level and the BUN/Cr ratio (r = 0.332, P < 0.025). Multiple regression analysis of the 3 variables yielded significant interdependence (P < 0.01). To evaluate the effect of diuretic therapy, 12 patients with severe CHF discontinued diuretic therapy and received, for 1 wk each, 10 and 100 meq Na diets in balance studies. PRA ranged from 0.14-16 ng/ml per h. Despite this range, there was no significant correlation between either serum Na or BUN/Cr ratio and PRA. The presence of marked hyponatremia and prerenal azotemia in patients with diuretic-treated CHF may suggest increased PRA. Substantial patient-to-patient variability limits the predictive values of these correlations. Although some clinical value may be derived from such correlations, they should not be used to draw major inferences regarding the severity of CHF or the pathophysiology of water balance in CHF.