Intrarenal determinants of sodium retention in mild heart failure: Effects of angiotensin-converting enzyme inhibition

Massimo Volpe, Paola Magri, Maria A E Rao, Sara Cangianiello, Luca DeNicola, Alessandro F. Mele, Bruno Memoli, Iolanda Enea, Speranza Rubattu, Bruna Gigante, Bruno Trimarco, Murray Epstein, Mario Condorelli

Research output: Contribution to journalArticlepeer-review


The onset and the mechanisms leading to Na+ retention in incipient congestive heart failure (CHF) have not been systematically investigated. To investigate renal Na+ handling in the early or mild stages of CHF, Na+ balance and renal clearances were assessed in 10 asymptomatic patients with idiopathic or ischemic dilated cardiomyopathy and mild heart failure (HF) off treatment (left ventricular ejection fraction, 29.7±2%) and in 10 matched normal subjects during a diet containing 100 mmol/d of NaCl and after 8 days of high salt intake (250 mmol/d). Six patients were studied again after 6 weeks of treatment with enalapril (5 mg/d PO). At the end of the high salt diet, in patients with mild HF the cumulative Na+ balance exceeded by 110 mmol that of normal subjects (F=3.86, P+ in the two groups, fractional excretion of Na+, fractional clearance of free water, and fractional excretion of K+ (indexes of distal delivery of Na+) increased in normal subjects and were reduced in patients with mild HF. During enalapril treatment, in the mild HF patients the cumulative Na+ balance was restored to normal; furthermore, enalapril significantly attenuated the abnormalities in the distal delivery of Na+. Our results indicate that a defective adaptation of Na+ reabsorption in the proximal nephron is associated with Na+ retention in response to increased salt intake in the early or mild stages of HF. These abnormalities of renal Na+ handling are largely reversed by enalapril.

Original languageEnglish
Pages (from-to)168-176
Number of pages9
Issue number2
Publication statusPublished - Aug 1997


  • Cardiomyopathy
  • Catecholamines
  • Kidney
  • Natriuretic peptides
  • Renin- angiotensin system

ASJC Scopus subject areas

  • Internal Medicine


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