Abstract
Employing a constant intravenous infusion technic, Sirota, Baldwin and Villarreal(1) have examined the diurnal variations of renal function in normal subjects. These studies reveal a significant decrease in urine flow during sleep, resulting primarily from increased tubular reabsorption of water, with only a slight and questionably significant decrease in glomerular filtration rate from 12 midnight to 4 a.m. The renal plasma flow did not vary significantly throughout the 24 hour period. The present report is concerned with similar studies in patients with congestive heart failure.
Methods. Simultaneous endogenous creatinine chromogen, inulin and p-aminohippurate clearances were determined during 4 to 6 hour periods throughout 24 hours in 10 male subjects in congestive heart failure. In 6 subjects sodium excretion was also followed. In 5 subjects cardiac failure was associated with rheumatic heart disease, in 4 with arteriosclerosis. and in 1 with cor pulmonale. Six of these patients at the time of study had persistent or increasing peripheral edema in spite of complete bed rest, low salt diet and complete digitalization. Of the other 4. 2 were edema-free and 2 were undergoing diuresis, spontaneous in 1 case and in the other as a result of digitalization. With the exception of 1 individual (E.); mercurial diuretics were withheld for a minimum of 5 days prior to study. The test substances were administered by means of a constant delivery pump at an approximate rate of 0.3 cc/min. Five per cent glucose in distilled water was used as the diluent.§ Analytical methods and details of technic in continuous 24 hour clearance studies have been reported previously(1).
Urine sodium was determined with the Perkin-Elmer internal standard flame photometer.
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