Abnormalities of sodium and H2O handling in chronic obstructive lung disease

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Abstract
The pathogenesis of edema and hyponatremia in chronic obstructive lung disease (COLD) is poorly understood. Previously, in nonedematous patients with hypercapnia, small increases in plasma renin activity occurred. In 25 hypercapnic, edematous, often hyponatremic, patients with COLD, measurement of renal hemodynamics, H2O and Na+ excretion, plasma levels of renin activity (PRA), plasma levels of aldosterone (PA), and the plasma arginine vasopressin (AVP)-osmolality relationship was obtained. A high prevalence of elevated PRA, PA and AVP levels excessively high for plasma osmolality was observed. Elevated PRA and PA correlated with the inability to excrete Na+; an elevated AVP level correlated with the inability to excrete H2O. In conjunction with the hypercapnia-hypoxia-mediated disturbance in renal function, stimulation of the renin-aldosterone level and of the AVP systems apparently contributes, respectively, to edema formation and to hyponatremia in advanced COLD.