284 Z. Fejfar 



evidence (see above) that renal blood flow and a decreased 

 excretion of electrolytes occurs in left ventricular failure and 

 mitral stenosis without right-sided decompensation, when 

 there is an increased pressure in the venous side of the pulmon- 

 ary circulation. 



On occasion, however, a sudden increase of pressure in this 

 part of the pulmonary circulation may be associated with a 

 rise of urine flow in patients with a heart disease. We have 

 followed haemodynamic changes in nine patients with acute 

 pulmonary oedema (Fejfar et al., 1958a); in three of them we 

 also studied renal haemodynamics and the excretion of 

 electrolytes. At the onset of recovery from pulmonary 

 oedema there was a depressed renal blood flow and the renal 

 fraction of CO started to increase before any significant changes 

 in cardiac output occurred. In two of these three patients the 

 rise in renal blood flow was accompanied by an increased 

 excretion of chloride (Fig. 6). A rise of pressure in the left 

 auricle and pulmonary veins is typical for acute pulmonary 

 oedema in patients with mitral stenosis or left ventricular 

 failure. It is therefore possible that this elevation of pressure 

 could influence renal blood flow, diuresis, and the excretion 

 of electrolytes. The diuresis was not, however, a water 

 diuresis as described by Sicker, Gauer and Henry (1952, 

 1954). 



Gomori and co-workers (1954) studied renal circulation in 

 dogs with crossed circulation under hypoxaemia. They 

 found a decrease in renal blood flow in a dog whose head was 

 perfused from the other body by hypoxic (venous) blood. 

 Following denervation of the kidneys, this vasoconstriction 

 either disappeared completely or was insignificant. 



Foldi and co-workers (1955) found in hypoxaemic dogs a 

 decrease in renal blood flow, excretion of water and electro- 

 lytes. In healthy subjects breathing a mixture of 10 per cent 

 oxygen there was also a decreased renal blood flow and elimi- 

 nation of electrolytes. On the other hand a low renal blood 

 flow, glomerular filtration rate and excretion of sodium 

 significantly increased in patients with congestive heart 



