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DISCUSSION 



McCance : Prof. Borst, can you bring together these discoveries about 

 nocturnal diuresis, reflex activity and aldosterone excretion? 



Borst : The role of aldosterone should not be exaggerated. Heart failure 

 and nocturia can be seen in patients with Addison's disease ; therefore in 

 the disturbance in water and electrolyte excretion of heart failure and 

 of nocturia the effect of aldosterone cannot be the only factor. We 

 believe that the evidence is in favour of the theory that salt retention in 

 the presence of normal kidneys is always largely effected through the 

 same pathways. The same mechanism is responsible for the retention 

 after haemorrhage, in nephrosis, in cirrhosis and in heart failure. On the 

 other hand we assume that salt diuresis is also always effected through 

 the same pathway. The characteristics of this mechanism can best be 

 studied in the excellent experimental conditions provided by patients 

 with paroxysmal tachycardia accompanied by polyuria. The attack of 

 tachycardia elicits the typical 'salt diuresis', though blood volume and 

 extracellular fluid volume remain constant. The diuretic stimulus must 

 therefore result from the change in heart action. The pulse rate acutely 

 rises from 80 to 160 and after a certain period falls suddenly to the original 

 rate. The consecutive portions of urine in patients who are on a standard- 

 ized diet show a brisk water diuresis followed by a gradual increase in 

 sodium output. The excretion pattern is very characteristic and is in 



