The renal dopaminergic system, neurohumoral activation, and sodium handling in heart failure

被引:12
作者
Ferreira, A
Bettencourt, P
Pimenta, J
Frioes, F
Pestana, M
Soares-da-Silva, P
Cerqueira-Gomes, M
机构
[1] Hosp Sao Joao, Serv Med 3, Dept Med 3, P-4200 Oporto, Portugal
[2] Univ Porto, Sch Med, Inst Pharmacol & Therapeut, P-4100 Oporto, Portugal
[3] Hosp Sao Joao, Div Nephrol, Oporto, Portugal
[4] Univ Porto, Sch Med, Unit Cardiovasc Res & Dev, P-4100 Oporto, Portugal
关键词
D O I
10.1067/mhj.2002.120292
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Dopamine of renal origin exerts natriuretic and diuretic actions by activating specific receptors located in the renal proximal tubular epithelial cells, Heart Failure (HF) is accompanied by activation of several neurohumoral systems. The interaction of these systems with the renal dopaminergic system and its effect on sodium handling in HF are not clarified. Methods and Results We studied 13 patients with decompensated New York Heart Association class III/IV HF and 17 sex- and age-matched patients with mild to moderate stable class I/II HF. We measured plasma catecholamines, aldosterone, type B natriuretic peptide (BNP), sodium, creatinine (UCr), and 24-hour urinary excretion of sodium, UCr, levo-3,4-dihydroxyphenylalanine (L-DOPA), 3-o-methyldopa, dopamine and its metabolites, 3,4-dihydroxyphenylacetic acid and homovallinic acid, and norepinephrine. All patients had HF of ischemic etiology. No statistically significant differences were found between the groups with respect to urine volume (1.79 +/- 0.23 L - d(-1) vs 2.20 +/- 0.18 L. d(-1), P =.18) and urinary sodium (161.3 +/- 27.5 mmol . d(-1) vs 232.9 +/- 28.8 mmol . d(-1), P = .12). Urinary L-DOPA was significantly lower in patients with decompensated class III/IV HF than in the other group (79.0 +/- 13.8 nmol . g UCr-1 vs 108.4 +/- 10.3 nmol . g UCr-1, P =.04). Urinary doparnine showed a nonstatistically significant trend to be slightly higher ( 1294.3 +/- 188.5 nmol . g UCr-1 953.2 +/- 107.4 nmol . g UCr-1, P =.14). Consequently, urinary dopamine/L-DOPA ratios were markedly higher in patients with decompensated class III/IV HF than in the other patients (20.6 +/- 3.4 vs 9.0 +/- 0.9, P <.00 1). Plasma L-DOPA (38.1 +/- 4.4 pmol . mL(-1) vs 40.0 +/- 3.0 pmol . mL(-1), P=.48), dopamine (37.0 +/- 6.3 pmol . mL(-1) vs 41.1 +/- 2.6 pmol . mL(-1), P =.53), 3,4-dihydroxyphenylacetic acid (5 1.7 +/- 1 1.7 pmol . mL(-1) vs 56.5 +/- 5.4 pmol . mL(-1), P =.09), and norepinephrine (9.5 +/- 2.4 pmol . mL(-1) vs 5.6 +/- 1.0 pmol . mL(-1), P =.12) did not cliff er between groups. Plasma alclosterone (180.2 +/- 28.0 pg . mL(-1) vs 69.9 +/- 13.3 pg . mL(-1), P <.001) and BNP (677.5 +/- 133.9 pg . mL(-1) vs 389.4 +/- 88.4 pg . mL(-1), P <.04) levels were higher in the decompensated class III/IV HF group than in the other group, whereas serum sodium was lower (137.3 +/- 1.2 mmol . L-1 vs 143.2 +/- 1.0 mmol . L-1, P =.00 1). Conclusions These results suggest that, in patients with HF, the increased renal utilization of L-DOPA may constitute a compensatory mechanism, activated in response to stimuli leading to sodium reabsorption.
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页码:391 / 397
页数:7
相关论文
共 30 条
  • [1] Mechanisms and management of renal dysfunction in heart failure
    Anand, IS
    Chugh, SS
    [J]. CURRENT OPINION IN CARDIOLOGY, 1997, 12 (03) : 251 - 258
  • [2] DOPAMINE CAUSES INHIBITION OF NA+-K+-ATPASE ACTIVITY IN RAT PROXIMAL CONVOLUTED TUBULE SEGMENTS
    APERIA, A
    BERTORELLO, A
    SERI, I
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY, 1987, 252 (01): : F39 - F45
  • [3] DOPAMINE FAILS TO INHIBIT RENAL TUBULAR SODIUM-PUMP IN HYPERTENSIVE RATS
    CHEN, CJ
    BEACH, RE
    LOKHANDWALA, MF
    [J]. HYPERTENSION, 1993, 21 (03) : 364 - 372
  • [4] RENAL AND CIRCULATORY MECHANISMS IN CONGESTIVE-HEART-FAILURE
    DZAU, VJ
    [J]. KIDNEY INTERNATIONAL, 1987, 31 (06) : 1402 - 1415
  • [5] DOPAMINE INHIBITS NA+-H+ EXCHANGER ACTIVITY IN RENAL BBMV BY STIMULATION OF ADENYLATE-CYCLASE
    FELDER, CC
    CAMPBELL, T
    ALBRECHT, F
    JOSE, PA
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY, 1990, 259 (02): : F297 - F303
  • [6] FERNANDES MH, 1993, ADV BIOSCI, V88, P21
  • [7] FERNANDES MH, 1994, J NEURAL TRANSM-SUPP, P101
  • [8] Renal synthesis of dopamine in asymptomatic post-infarction left ventricular systolic dysfunction
    Ferreira, A
    Bettencourt, P
    Pestana, M
    Oliveira, N
    Serrao, P
    Maciel, MJ
    Cerqueira-Gomes, M
    Soares-da-Silva, P
    [J]. CLINICAL SCIENCE, 2000, 99 (03) : 195 - 200
  • [9] Goldstein D S, 1995, Hypertens Res, V18 Suppl 1, pS93, DOI 10.1291/hypres.18.SupplementI_S93
  • [10] URINARY-EXCRETION OF DIHYDROXYPHENYLALANINE AND DOPAMINE DURING ALTERATIONS OF DIETARY SALT INTAKE IN HUMANS
    GOLDSTEIN, DS
    STULL, R
    EISENHOFER, G
    GILL, JR
    [J]. CLINICAL SCIENCE, 1989, 76 (05) : 517 - 522