Balsano F
Istituto di I Clinica Medica Generale e Terapia Medica, Università degli Studi di Roma La Sapienza, Italy.
Ann Ital Med Int. 1991 Jan-Mar;6(1 Pt 2):93-106.
In the first part of the text the main elements of renal physiology are mentioned as well as the role played by sodium-modulating hormones in the preservation of sodium and water homeostasis. A personal contribution concerns the release as well as the circadian rhythm of atrial natriuretic peptide (ANP) and of the digitalis-like substance (DLS). In the second part, the problem is dealt with from a pathophysiologic point of view, with reference made to the literature, and to our own data. In particular, the problem of essential hypertension with reduced levels of plasma renin activity (PRA) is thoroughly analyzed. As is well known, this kind of hypertension is characterized by normal plasma aldosterone levels associated with reduced kallikrein urinary excretion. The data we gathered not only confirmed these findings but also enabled us to point out other typical features of this particular kind of hypertension: normal values of vasopressin, elevation of ANP and DLS, hyperactivity of Na+/K+ cotransport. The introduction of a single variant in the sodium-modulating systems confirmed that the low PRA patient also behaves distinctively from a dynamic point of view. In fact, prostaglandin inhibition determines hypertension only in these patients, while both oral kallikrein administration and intravenous ANP administration were particularly effective because of a primitive deficit of the natriuretic paracrine systems paralleled by a compensatory increase of ANP. After identifying this group of hypertensive patients we intended to ascertain whether, even in the normal or high PRA patients, it was possible to identify a sub-group of subjects with altered sodium-modulation. The patients we examined were subdivided according to their hormonal and renal response to a saline load, and to angiotensin II, into "modulators" (with normal) and "nonmodulators" (with reduced sodium excretion capacity). An analysis of the hormonal characteristics of non-modulators identified an increased responsiveness of all sodium-modulation systems and not only of the renin-angiotensin-aldosterone system as pointed out by some other authors. The last part of the text is devoted to clinical and therapeutic problems. The behaviour of the daily blood pressure profile in patients with essential hypertension, and then the influence that sodium-modulating systems may have on pressure are discussed. The consequences of a progressive reduction in renal function on the circadian rhythm of arterial pressure are then assessed, and, at the same time, how renal impairment parallels the flattening of the daily pressure rate is observed.
在文本的第一部分，提到了肾脏生理学的主要元素以及钠调节激素在维持钠和水平衡中所起的作用。个人的贡献涉及心房利钠肽（ANP）和洋地黄样物质（DLS）的释放以及昼夜节律。在第二部分中，从病理生理学的角度探讨了这个问题，并参考了文献和我们自己的数据。特别是，对血浆肾素活性（PRA）水平降低的原发性高血压问题进行了深入分析。众所周知，这种高血压的特征是血浆醛固酮水平正常，同时尿激肽释放酶排泄减少。我们收集的数据不仅证实了这些发现，还使我们能够指出这种特殊类型高血压的其他典型特征：血管加压素值正常、ANP和DLS升高、Na+/K+共转运亢进。在钠调节系统中引入单一变量证实，低PRA患者从动态角度来看也表现出独特的行为。事实上，前列腺素抑制仅在这些患者中导致高血压，而口服激肽释放酶和静脉注射ANP都特别有效，这是因为利钠旁分泌系统存在原始缺陷，同时ANP出现代偿性增加。在确定了这组高血压患者后，我们打算确定，即使在正常或高PRA患者中，是否有可能识别出钠调节改变的亚组受试者。我们检查的患者根据其对盐水负荷和血管紧张素II的激素和肾脏反应，分为“调节者”（反应正常）和“非调节者”（钠排泄能力降低）。对非调节者的激素特征分析表明，所有钠调节系统的反应性均增加，而不仅仅是其他一些作者所指出的肾素 - 血管紧张素 - 醛固酮系统。文本的最后一部分致力于临床和治疗问题。讨论了原发性高血压患者每日血压曲线的行为，以及钠调节系统可能对血压产生的影响。然后评估肾功能逐渐减退对动脉压昼夜节律的影响，同时观察肾功能损害与每日压力率变平之间的平行关系。
