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July 1982

Abnormalities of Sodium and H2O Handling in Chronic Obstructive Lung Disease

Author Affiliations

From the Pulmonary (Drs Farber, Manfredi, and Roberts) and Endocrinology (Dr Robertson) Research Laboratories and the Specialized Center of Research in Hypertension (Drs Weinberger and Fineberg), Department of Medicine, Veterans Administration Medical Center, Indiana University School of Medicine, Indianapolis. Dr Robertson is now with the University of Chicago Pritzker School of Medicine.

Arch Intern Med. 1982;142(7):1326-1330. doi:10.1001/archinte.1982.00340200086019

• The pathogenesis of edema and hyponatremia in chronic obstructive lung disease (COLD), is poorly understood. Previously, in nonedematous patients with hypercapnia, small increases in plasma renin activity occurred, which prompted this study. In 25 hypercapnic, edematous, often hyponatremic patients with COLD, we measured renal hemodynamics, H2O, and sodium (Na+) excretion, plasma levels of renin activity (PRA), plasma levels of aldosterone (PA), and the plasma arginine vasopressin (AVP)-osmolality relationship. A high prevalence of elevated PRA, PA, and AVP levels excessively high for plasma osmolality was observed. Elevated PRA and PA correlated with the inability to excrete Na+; an elevated AVP level correlated with the inability to excrete H2O. These data suggest that, in conjunction with the hypercapnia-hypoxia-mediated disturbance in renal function, stimulation of the renin-aldosterone level and of the AVP systems contributes, respectively, to edema formation and to hyponatremia in advanced COLD.

(Arch Intern Med 1982;142:1326-1330)