Document Detail

Edematous states: an overview.
MedLine Citation:
PMID:  9185096     Owner:  NLM     Status:  MEDLINE    
What I have tried to describe in these brief introductory statements are the key elements stimulating renal sodium retention mediated by arterial underfilling, as illustrated by the volume repletion reaction (Fig. 3). They may be summarized by saying that edematous states characterized by underfilling-most notably systolic pump failure-represent, in fact, suicidal arterial filling. This point of view is illustrated in Figure 8. Essentially, as shown in Figure 8, the original reduction in filling of the arterial tree, by provoking both hemodynamic changes and diminished sodium avidity, has the net effect of increasing end diastolic volume and, for a time, cardiac output, but at two great expenses: an increased afterload and a an increased preload. In the end, these latter two effects produce a reduced ejection fraction which obviously propagates the syndrome of systolic failure. Thus, suicidal arterial filling represents a vicious cycle in which homeostatic mechanisms set into play an attempt to compensate for inadequate arterial filling, which inevitably leads to increasing degrees of cardiac dysfunction and, hence, to deterioration of the patient. I have enjoyed presenting these introductory remarks. I am certain that subsequent talks in this Conference will consider more explicitly the provocative issue of the "overfilling" hypothesis as a mechanism for sodium retention in edematous states such as the nephrotic syndrome and cirrhosis.
T E Andreoli
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Kidney international. Supplement     Volume:  59     ISSN:  0098-6577     ISO Abbreviation:  Kidney Int. Suppl.     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-07-24     Completed Date:  1997-07-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7508622     Medline TA:  Kidney Int Suppl     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S2-10     Citation Subset:  IM    
Department of Internal Medicine, University of Arkansas College of Medicine, Little Rock, USA.
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MeSH Terms
Edema / etiology*
Kidney / metabolism
Sodium / metabolism
Reg. No./Substance:

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