Renal Excretion of Antidiuretic Hormone in Healthy Subjects and Patients with Renal Failure

Abstract

1. Urinary clearance of antidiuretic hormone (ADH) has been measured under basal conditions and during intravenous administration of arginine vasopressin in ten healthy subjects, and only under basal conditions in 18 patients with chronic renal failure and seven patients with acute renal failure at the polyuric phase of the disease. 2. In healthy subjects studied under conditions of mild water diuresis, plasma concentration, urinary excretion rate, urinary clearance and fractional clearance of ADH were 3.3 ± 0.36 pg/ml, 25.2 ± 5.5 pg/min, 7.5 ± 1.2 ml/min and 6.4 ± 1.0% (means ± sem) respectively. When plasma ADH was raised to levels between 7 and 26 pg/ml during intravenous administration of the hormone, urinary excretion rate and urinary clearance of ADH increased. Tubular reabsorption of ADH did not reach a plateau but progressively increased in the range of plasma ADH studied. 3. In patients with chronic renal failure, plasma concentration, urinary excretion rate, urinary clearance and fractional clearance of ADH were 2.8 ± 0.19 pg/ml, 9.4 ± 2.0 pg/min, 3.4 ± 0.6 ml/min and 10.0 ± 2.9% (means ± sem) respectively. Urinary excretion rate and urinary clearance were significantly lower than in healthy subjects. 4. In patients with acute renal failure, plasma concentration, urinary excretion rate, urinary clearance and fractional clearance of ADH were 4.6 ± 0.47 pg/ml, 52.8 ± 15.8 pg/min, 9.5 ± 2.7 ml/min and 24.9 ± 4.4% (means ± sem) respectively. Urinary excretion rate and fractional clearance were higher than in healthy subjects and patients with chronic renal failure. 5. These results demonstrate that most of the filtered ADH is reabsorbed by the tubules. The reabsorptive capability is markedly diminished in patients with acute renal failure at the polyuric phase of the disease.