Radó J P, van Wimersma Greidanus T B, Boer P, Mees E J
Endokrinologie. 1982 Jun;79(2):266-80.
In two from 3 hyperkalemic patients with chronic glomerulonephritis associated with suppressed aldosterone production ("selective hypoaldosteronism") fractional free water excretion increased and urine osmolality decreased during sodium (Na) restriction. In one of the patients with severe renal concentrating defect in combination with partial vasopressin deficiency polyuria was paradoxically accentuated by lowered Na intake. Na restriction induced 1. a dramatic increase in plasma aldosterone levels, 2. a decrease in glomerular filtration rate associated with a marked disturbance in the glomerulotubular balance resembling to the effects of volume expansion, and 3. a decrease in urinary arginine vasopressin excretion. Paradoxical enhancement of water excretion was explained by increased delivery of filtrate into the distal nephron, increased abstraction of Na from the tubular fluid together with insufficient water permeability of the collecting tubules and lowered vasopressin production.
在3例患有慢性肾小球肾炎且醛固酮分泌受抑制（“选择性醛固酮减少症”）的高钾血症患者中，有2例在限制钠（Na）摄入期间，自由水清除分数增加，尿渗透压降低。在1例伴有部分抗利尿激素缺乏的严重肾浓缩功能障碍患者中，低钠摄入反而使多尿症状加重。限制钠摄入导致：1. 血浆醛固酮水平显著升高；2. 肾小球滤过率降低，同时肾小球-肾小管平衡出现明显紊乱，类似于血容量扩张的影响；3. 尿中精氨酸抗利尿激素排泄减少。滤过液进入远端肾单位的量增加、肾小管液中钠的重吸收增加、集合管水通透性不足以及抗利尿激素分泌减少，解释了水排泄的反常增加。
