Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1995 Aug;50(8):838–845. doi: 10.1136/thx.50.8.838

Hormonal, renal, and autonomic nerve factors involved in the excretion of sodium and water during dynamic salt and water loading in hypoxaemic chronic obstructive pulmonary disease.

A G Stewart 1, J C Waterhouse 1, C G Billings 1, P H Baylis 1, P Howard 1
PMCID: PMC474898  PMID: 7570434

Abstract

BACKGROUND--Some patients with hypoxaemic chronic obstructive pulmonary disease (COPD) develop sodium and water retention and a subclinical autonomic neuropathy. The possibility that these might be associated has been investigated. METHODS--The ability of 24 patients with COPD to excrete a 6 ml/kg 2.7% intravenous saline or 15 ml/kg oral water load was studied and changes in plasma electrolyte levels, osmolality, plasma aldosterone and vasopressin levels, urinary volume and sodium content, glomerular filtration rate, renal blood flow, and cardiovascular autonomic nerve function were measured. Patients were divided into groups of eight: those in group A (controls) had mild COPD with a Pa02 of > 9 kPa and no oedema, patients in group B were more hypoxaemic but had never been oedematous, whilst those in group C were hypoxaemic and mildly oedematous at the time of the study. RESULTS--Patients in groups B and C excreted less sodium and water during saline loading and a lesser proportion of the water load. Patients in group C had a reduction in renal blood flow and glomerular filtration rate and all had a subclinical autonomic neuropathy, which was also found in three patients in group B. Their plasma aldosterone level was raised but did suppress appropriately on saline loading. Vasopressin levels were abnormally raised for the osmolality in patients in group C and in those with autonomic dysfunction throughout the water load and at 240 minutes after the salt load. Sodium and urine excretion was highly correlated with autonomic dysfunction, aldosterone levels at time zero, and renal blood flow. The 11 patients with autonomic dysfunction were more likely to be oedematous, more hypoxaemic, excreted much less urine and sodium, had lower glomerular filtration rate and renal blood flow, and higher aldosterone and vasopressin levels than the remaining patients. CONCLUSIONS--In patients with COPD the inability to excrete sodium and water is multifactorial. This is the first study to show that autonomic dysfunction is at least associated and might play an important part in the impaired sodium and water homeostasis seen in patients with severe COPD.

Full text

PDF
838

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bell-Reuss E., Trevino D. L., Gottschalk C. W. Effect of renal sympathetic nerve stimulation on proximal water and sodium reabsorption. J Clin Invest. 1976 Apr;57(4):1104–1107. doi: 10.1172/JCI108355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bersentes T. J., Simmons D. H. Effects of acute acidosis on renal hemodynamics. Am J Physiol. 1967 Mar;212(3):633–640. doi: 10.1152/ajplegacy.1967.212.3.633. [DOI] [PubMed] [Google Scholar]
  3. Bichet D. G. Water disturbances in cardiac failure. Baillieres Clin Endocrinol Metab. 1989 Aug;3(2):559–574. doi: 10.1016/s0950-351x(89)80015-1. [DOI] [PubMed] [Google Scholar]
  4. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  5. Decaux G., Cauchie P., Soupart A., Kruger M., Delwiche F. Role of vagal neuropathy in the hyponatraemia of alcoholic cirrhosis. Br Med J (Clin Res Ed) 1986 Dec 13;293(6561):1534–1536. doi: 10.1136/bmj.293.6561.1534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ewing D. J., Clarke B. F. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982 Oct 2;285(6346):916–918. doi: 10.1136/bmj.285.6346.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Farber M. O., Kiblawi S. S., Strawbridge R. A., Robertson G. L., Weinberger M. H., Manfredi F. Studies on plasma vasopressin and the renin-angiotensin-aldosterone system in chronic obstructive lung disease. J Lab Clin Med. 1977 Aug;90(2):373–380. [PubMed] [Google Scholar]
  8. Farber M. O., Roberts L. R., Weinberger M. H., Robertson G. L., Fineberg N. S., Manfredi F. Abnormalities of sodium and H2O handling in chronic obstructive lung disease. Arch Intern Med. 1982 Jul;142(7):1326–1330. [PubMed] [Google Scholar]
  9. Farber M. O., Weinberger M. H., Robertson G. L., Fineberg N. S. The effects of angiotensin-converting enzyme inhibition on sodium handling in patients with advanced chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987 Oct;136(4):862–866. doi: 10.1164/ajrccm/136.4.862. [DOI] [PubMed] [Google Scholar]
  10. Gibson D. G., Marshall J. C., Lockey E. Assessment of proximal tubular sodium reabsorption during water diuresis in patients with heart disease. Br Heart J. 1970 May;32(3):399–405. doi: 10.1136/hrt.32.3.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. HAMMOND J. D., MACKINNON J., SMITH W. D., STUART-HARRIS C. H. The renal circulation in chronic pulmonary disease and pulmonary heart failure. Q J Med. 1956 Jul;25(99):389–405. [PubMed] [Google Scholar]
  12. Karim F., Poucher S. M., Summerill R. A. The effects of stimulating carotid chemoreceptors on renal haemodynamics and function in dogs. J Physiol. 1987 Nov;392:451–462. doi: 10.1113/jphysiol.1987.sp016790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. MacNee W. Right ventricular function in cor pulmonale. Cardiology. 1988;75 (Suppl 1):30–40. doi: 10.1159/000174443. [DOI] [PubMed] [Google Scholar]
  14. Middleton H. C., Peake M. D., Howard P. Hypoxaemia in chronic obstructive bronchitis. Thorax. 1979 Apr;34(2):213–216. doi: 10.1136/thx.34.2.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Morris M., Alexander N. Baroreceptor influences on oxytocin and vasopressin secretion. Hypertension. 1989 Feb;13(2):110–114. doi: 10.1161/01.hyp.13.2.110. [DOI] [PubMed] [Google Scholar]
  16. PERLMUTT J. H. EFFECT OF VAGOTOMY ON RENAL FUNCTION DURING WATER DIURESIS. Proc Soc Exp Biol Med. 1964 Jun;116:270–273. doi: 10.3181/00379727-116-29222. [DOI] [PubMed] [Google Scholar]
  17. PLATTS M. M., HAMMOND J. D., STUART-HARRIS C. H. A study of cor pulmonale in patients with chronic bronchitis. Q J Med. 1960 Oct;29:559–574. [PubMed] [Google Scholar]
  18. Patakas D., Louridas G., Kakavelas E. Reduced baroreceptor sensitivity in patients with chronic obstructive pulmonary disease. Thorax. 1982 Apr;37(4):292–295. doi: 10.1136/thx.37.4.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Peters A. M., Gunasekera R. D., Henderson B. L., Brown J., Lavender J. P., De Souza M., Ash J. M., Gilday D. L. Noninvasive measurement of blood flow and extraction fraction. Nucl Med Commun. 1987 Oct;8(10):823–837. doi: 10.1097/00006231-198710000-00009. [DOI] [PubMed] [Google Scholar]
  20. Reihman D. H., Farber M. O., Weinberger M. H., Henry D. P., Fineberg N. S., Dowdeswell I. R., Burt R. W., Manfredi F. Effect of hypoxemia on sodium and water excretion in chronic obstructive lung disease. Am J Med. 1985 Jan;78(1):87–94. doi: 10.1016/0002-9343(85)90467-x. [DOI] [PubMed] [Google Scholar]
  21. Renzetti A. D., Jr, McClement J. H., Litt B. D. The Veterans Administration cooperative study of pulmonary function. 3. Mortality in relation to respiratory function in chronic obstructive pulmonary disease. Am J Med. 1966 Jul;41(1):115–129. doi: 10.1016/0002-9343(66)90009-x. [DOI] [PubMed] [Google Scholar]
  22. Rooke P., Baylis P. H. A new sensitive radioimmunoassay for plasma arginine vasopressin. J Immunoassay. 1982;3(2):115–131. doi: 10.1080/15321818208056990. [DOI] [PubMed] [Google Scholar]
  23. SCHEDL H. P., BARTTER F. C. An explanation for and experimental correction of the abnormal water diuresis in cirrhosis. J Clin Invest. 1960 Feb;39:248–261. doi: 10.1172/JCI104035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Schrier R. W., Berl T. Mechanism of the antidiuretic effect associated with interruption of parasympathetic pathways. J Clin Invest. 1972 Oct;51(10):2613–2620. doi: 10.1172/JCI107079. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Slick G. L., DiBona G. F., Kaloyanides G. J. Renal sympathetic nerve activity in sodium retention of acute caval constriction. Am J Physiol. 1974 Apr;226(4):925–932. doi: 10.1152/ajplegacy.1974.226.4.925. [DOI] [PubMed] [Google Scholar]
  26. Stewart A. G., Bardsley P. A., Baudouin S. V., Waterhouse J. C., Thompson J. S., Morice A. H., Howard P. Changes in atrial natriuretic peptide concentrations during intravenous saline infusion in hypoxic cor pulmonale. Thorax. 1991 Nov;46(11):829–834. doi: 10.1136/thx.46.11.829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Stewart A. G., Marsh F., Waterhouse J. C., Howard P. Autonomic nerve dysfunction in COPD as assessed by the acetylcholine sweat-spot test. Eur Respir J. 1994 Jun;7(6):1090–1095. [PubMed] [Google Scholar]
  28. Stewart A. G., Waterhouse J. C., Billings C. G., Baylis P., Howard P. Effects of angiotensin converting enzyme inhibition on sodium excretion in patients with hypoxaemic chronic obstructive pulmonary disease. Thorax. 1994 Oct;49(10):995–998. doi: 10.1136/thx.49.10.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Stewart A. G., Waterhouse J. C., Howard P. Cardiovascular autonomic nerve function in patients with hypoxaemic chronic obstructive pulmonary disease. Eur Respir J. 1991 Nov;4(10):1207–1214. [PubMed] [Google Scholar]
  30. Taher M. S., McLain L. G., McDonald K. M., Schrier R. W., Gilbert L. K., Aisenbrey G. A., McCool A. L. Effect of beta adrenergic blockade on renin response to renal nerve stimulation. J Clin Invest. 1976 Feb;57(2):459–465. doi: 10.1172/JCI108297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Vatner S. F., Manders W. T., Knight D. R. Vagally mediated regulation of renal function in conscious primates. Am J Physiol. 1986 Apr;250(4 Pt 2):H546–H549. doi: 10.1152/ajpheart.1986.250.4.H546. [DOI] [PubMed] [Google Scholar]
  32. Weekley L. B. Angiotensin-II acts centrally to alter renal sympathetic nerve activity and the intrarenal renin-angiotensin system. Cardiovasc Res. 1991 May;25(5):353–363. doi: 10.1093/cvr/25.5.353. [DOI] [PubMed] [Google Scholar]
  33. White R. J., Woodings D. F. Impaired water handling in chronic obstructive airways disease. Br Med J. 1971 Jun 5;2(5761):561–563. doi: 10.1136/bmj.2.5761.561. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES