WATER AND ELECTROLYTE METABOLISM 

 IN CONGESTIVE FAILURE 



Z. Fejfar 



Institute for Cardiovascular Research^ 

 Prague — Krc 



The role of the kidney in congestive failure 



The genesis of abnormal water and electrolyte metabolism 

 in congestive failure is at present generally attributed to im- 

 paired renal function. It was previously thought that in- 

 creased systemic venous pressure (and hence the imbalance of 

 Starling forces in the capillaries) was the main factor initiating 

 these phenomena. Warren and Stead (1944) observed in some 

 cardiac patients an increase in body weight after the adminis- 

 tration of salt before any significant rise in central venous 

 pressure. This indicated that another mechanism might be 

 responsible for the retention of salt and water in chronic 

 congestive failure. Merrill (1946) confirmed the earlier findings 

 of Seymour and co-workers (1942) that patients with con- 

 gestive failure have a diminished renal blood flow; moreover 

 he found that the decrease in renal blood flow was far greater 

 than the diminution of cardiac output. 



It was, however, not clear whether the retention of electro- 

 lytes and water in chronic congestive heart failure was due to 

 a primary decrease in renal function or to the decrease in 

 renal blood flow and function as a consequence of the increase 

 in central venous pressure. 



It appeared to us in 1947 (see Brod and Fejfar, 1949, 1950) 

 that only observations of haemodynamic events at the time 

 when water balance was changing could elucidate this problem. 

 Patients with heart disease on the borderline of right heart 

 failure usually have a low urine output during the day, but 

 an increased urine flow at night. This spontaneous diuTcsis 



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