Fluid homeostasis in chronic obstructive lung disease

被引:42
作者
de Leeuw, PW
Dees, A
机构
[1] State Univ Limburg Hosp, Dept Med, NL-6202 AZ Maastricht, Netherlands
[2] Ikazia Ziekenhuis, Dept Med, Rotterdam, Netherlands
关键词
chronic obstructive pulmonary; disease; cor pulmonale; natriuretic peptides; oedema; renal; renin-angiotensin system;
D O I
10.1183/09031936.03.00000603a
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Chronic obstructive pulmonary disease (COPD) often leads to massive oedema and the development of what is usually called cor pulmonale. The mechanisms by which patients with COPD retain salt and water are not completely understood. Several abnormalities have been found including reduced renal blood How with relatively preserved glomerular filtration rate and elevated levels of renin, aldosterone, arginine vasopressin and atrial natriuretic peptide. Generally, these abnormalities worsen with the severity of COPD and are most marked during the oedematous phases. Cardiac output is remarkably normal, suggesting that "cor pulmonale" is not primarily a cardiac disorder but rather a condition of volume overload due to activation of sodium-retaining mechanisms. The stimulus for this activation could be underfilling of the arterial system (reduced effective circulating volume) secondary to a fall in total peripheral vascular resistance. The latter is caused by hypercapnia-induced dilation of the precapillary sphincters. Apparently, the massive sodium retention by the kidney is not able to restore the circulating volume and a vicious cycle ensues ultimately leading to a clinical picture which resembles right-sided heart failure. Predictably, only blockade of the effects of carbon dioxide at the level of the precapillary sphincters would be able to halt this process.
引用
收藏
页码:33S / 40S
页数:8
相关论文
共 51 条
[1]  
Abraham William T., 1997, P72
[2]   PLASMA-LEVELS OF ATRIAL-NATRIURETIC-FACTOR, RENIN-ACTIVITY, AND ALDOSTERONE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - RESPONSE TO O-2 REMOVAL AND TO HYPEROXIA [J].
ADNOT, S ;
ANDRIVET, P ;
CHABRIER, PE ;
DEFOUILLOY, C ;
VIOSSAT, I ;
BRAQUET, P ;
ATLAN, G ;
BRUNBUISSON, C .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1990, 141 (05) :1178-1184
[3]   ATRIAL NATRIURETIC FACTOR IN CHRONIC OBSTRUCTIVE LUNG-DISEASE WITH PULMONARY-HYPERTENSION - PHYSIOLOGICAL CORRELATES AND RESPONSE TO PEPTIDE INFUSION [J].
ADNOT, S ;
ANDRIVET, P ;
CHABRIER, PE ;
PIQUET, J ;
PLAS, P ;
BRAQUET, P ;
ROUDOTTHORAVAL, F ;
BRUNBUISSON, C .
JOURNAL OF CLINICAL INVESTIGATION, 1989, 83 (03) :986-993
[4]   ATRIAL-NATRIURETIC-PEPTIDE CONCENTRATIONS AND PULMONARY HEMODYNAMICS IN PATIENTS WITH PULMONARY-ARTERY HYPERTENSION [J].
ADNOT, S ;
CHABRIER, PE ;
ANDRIVET, P ;
VIOSSAT, I ;
PIQUET, J ;
BRUNBUISSON, C ;
GUTKOWSKA, Y ;
BRAQUET, P .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1987, 136 (04) :951-956
[5]   Atrial natriuretic peptide levels and plasma volume contraction in acute alveolar hypoxia [J].
Albert, TSE ;
Tucker, VL ;
Renkin, EM .
JOURNAL OF APPLIED PHYSIOLOGY, 1997, 82 (01) :102-110
[6]   PATHOGENESIS OF CONGESTIVE STATE IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - STUDIES OF BODY-WATER AND SODIUM, RENAL-FUNCTION, HEMODYNAMICS, AND PLASMA HORMONES DURING EDEMA AND AFTER RECOVERY [J].
ANAND, IS ;
CHANDRASHEKHAR, Y ;
FERRARI, R ;
SARMA, R ;
GULERIA, R ;
JINDAL, SK ;
WAHI, PL ;
POOLEWILSON, PA ;
HARRIS, P .
CIRCULATION, 1992, 86 (01) :12-21
[7]   SHORT-TERM EFFECT OF OXYGEN ON RENAL HEMODYNAMICS IN PATIENTS WITH HYPOXEMIC CHRONIC OBSTRUCTIVE AIRWAYS DISEASE [J].
BAUDOUIN, SV ;
BOTT, J ;
WARD, A ;
DEANE, C ;
MOXHAM, J .
THORAX, 1992, 47 (07) :550-554
[8]   Oedema and cor pulmonale revisited [J].
Baudouin, SV .
THORAX, 1997, 52 (05) :401-402
[9]   HYPONATREMIA AND INCREASED EXCHANGEABLE SODIUM IN CHRONIC OBSTRUCTIVE LUNG DISEASE [J].
BAUER, FK ;
TELFER, N ;
HERBST, HH ;
AUSTIN, RC ;
HETTER, B .
AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1965, 250 (03) :245-&
[10]  
BAUM GL, 1959, AM HEART J, V4, P593