ANGIOTENSIN BLOOD LEVELS IN HEMORRHAGIC HYPOTENSION AND OTHER RELATED CONDITIONS

Influence of selective nitric oxide synthetase inhibitor for treatment of refractory haemorrhagic shock

OBJECTIVE

Haemorrhagic shock (HS) is implicated in the induction of inducible nitric oxide synthase that leads to increased production of nitric oxide (NO). We investigated the influence of aminoguanidine (AG), a selective iNOS inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), a non-selective inhibitor and S-Nitroso-N-acetylpenicillamine (SNAP), a NO donor, each of which was given with (+) or without (-) angiotensin II (ANGII), a vasoconstrictor, on the survival rate of HS decompensatory phased (HSDP) rats.

MATERIALS AND METHODS

HSDP was achieved via a constant pressure method. Organs were harvested and analyzed from rats sacrificed 72 h after HSDP or upon death. Plasma collected from HSDP rats were used to measure nitrate/nitrite, GOT and creatinine levels.

RESULTS

AG+ANGII-treated rats had significantly higher survival rates compared to the other treatment groups, 72 h following HSDP. A marked increase in MABP level was observed in AG+ANGII-treated rats when compared to other treatment groups. Histological examinations also showed a reduction of organ damage in AG+ANGII-treated rats compared to other treatment groups. Nitrate/nitrite level, glutamic oxalacetic transaminase (GOT) level and creatinine level were also significantly improved in AG+ANGII-treated rats compared to the other groups.

CONCLUSIONS

A greater beneficial effect was achieved with treatment by the AG+ANGII combination. Our experiments showed that the inhibition of excessive NO formation that occurred during HSDP, had augmented the vascular responsiveness effect of ANGII following protracted HS.

The role of inducible nitric oxide synthase inhibitor on the arteriolar hyporesponsiveness in hemorrhagic-shocked rats

Hemorrhagic shock (HS) has been implicated in the induction of inducible nitric oxide synthase (iNOS) that leads to increase production of nitric oxide (NO). Recently, NO has been implicated to cause hyporesponsiveness of blood vessel in vitro towards vasoconstrictors in refractory (decompensated) HS. In our in vivo model, we examined the effects of aminoguanidine (AG), a known iNOS inhibitor, with angiotensin II (ANG II), a vasoconstrictor, following hemorrhagic shock decompensatory phase (HSDP) on percentage survival, vascular responsiveness, mean arterial blood pressure (MABP), heart rate and mean nitrate/nitrite levels in anaesthetized rats. HSDP (3 h) was achieved via constant pressure method (40-45 mmHg). MABP and heart rate was measured via the left carotid artery. Plasma collected from HSDP rats was used to measure nitrate/nitrite levels. Vascular hyporeactivity to ANG II was carried out using HSDP aortic strips, precontracted with KCl and noradrenaline. Sham-operated rats served as controls. HSDP rats decreased percentage survival, vascular contractility to ANG II and noradrenaline, MABP, heart rate while showing increased levels of nitrate/nitrite. Infusion of AG with ANG II, increased percentage survival and had reversed these cardiovascular effects of HSDP rats. This study indicates that excessive NO formation from iNOS activity induces vascular hyporeactivity and decompensation in HSDP. This might suggest that selective NOS inhibitor, AG, when coupled with ANG II, show reduction in NO's effect in HSDP.

Effect of [1-Sar,8-Thr]-angiotensin II on the hyperglycemic response to hemorrhage in adrenodemedullated and guanethidine-treated rats

The present experiments were designed to further investigate the action of an angiotensin II antagonist on the hyperglycemic response to hemorrhage (1.2 ml/100 g b.wt./2 min). The animals were divided into 3 experimental groups; (1) sham-operated animals submitted to intravenous administration of [1-Sar,8-Thr]-angiotensin II (sarthran), an antagonist of angiotensin II (750 ng/100 g b.wt. as a bolus plus an infusion of 25 ng/100 g b.wt./min over 30 min), which greatly attenuated (51.8% lower than controls; P < 0.01) the hyperglycemic response to hemorrhage; (2) animals submitted to adrenodemedullation which decreased the hyperglycemic response to hemorrhage by 64% (P < 0.01). However, sarthran infusion into adrenodemedullated rats caused a 38.5% further decrease in hyperglycemic response to hemorrhage (P < 0.01); and (3) intact animals submitted to blockade of sympathetic noradrenergic pathways by treatment with guanethidine (10 mg/100 g b.wt.), which greatly decreased the baseline value of plasma glucose (64.1 +/- 3.5 mg% vs. 125.3 +/- 4.5 mg%, P < 0.01), and reduced the hyperglycemic response to hemorrhage by 34% (P < 0.01). Sarthran infusion into guanethidine-treated rats caused a further 34% decrease in hyperglycemic response to hemorrhage (P < 0.01). These data indicate that angiotensin II has a direct hyperglycemic effect in addition to its action on sympathetic nervous system activation and adrenomedullary secretion.

Hyperglycemic action of angiotensin II in freely moving rats

Angiotensin II has been implicated in the regulation of liver glycogen phosphorylase. Although it has been suggested that angiotensin II can raise blood glucose levels during hemorrhage, experimental data have not been presented. In the present study, the effect of angiotensin II on blood glucose levels was studied in freely moving rats, divided in three experimental groups: 1) intravenous administration of angiotensin II (0.48, 1.9, or 4.8 nmol) caused a dose-dependence response; 2) intracerebroventricular administration of angiotensin II (1.9 or 4.8 nmol) did not cause any significant change in glycemia compared with saline-treated controls; 3) intravenous administration of [Sar1,Thr8]angiotensin II, an antagonist of angiotensin II (750 ng/100 g b. wt. as a bolus plus a continuous injection of 25 ng/100 g b. wt./min over 30 min), greatly attenuated (39.2% lower than controls; p < 0.01) the hyperglycemic response to hemorrhage (1.2 ml/100 g b.wt.). These data indicate an in vivo involvement of angiotensin II in blood glucose regulation.

Effect of bilateral nephrectomy on the recovery of blood pressure after acute hemorrhage in rats: role of renin-angiotensin system

The effect of bilateral nephrectomy, and administration of an inhibitor of angiotensin converting enzyme, on the recovery of arterial blood pressure after hemorrhage (loss of 1% of b.wt), was studied in male Sprague-Dawley rats. Neither manoeuver significantly affected the recovery of blood pressure within the first 10 min after hemorrhage. Thereafter, the recovery of the blood pressure was markedly suppressed. The study suggests that the initial recovery of blood pressure is unrelated to the kidneys, but the later one requires their presence and depends on the activity of the renin-angiotensin system.

Circulatory effects of renin-angiotensin system antagonists during halothane anaesthesia in hypertensive rats

The circulatory effects of captopril, an angiotensin I-converting enzyme inhibitor, and saralasin, a competitive angiotensin II antagonist, were studied during halothane anaesthesia in spontaneously hypertensive (SH) rats. Captopril decreased blood pressure significantly in unanaesthetized rats. Pretreatment with indomethacin, a prostaglandin synthesis inhibitor, did not modify the antihypertensive action of captopril. During 1 MAC halothane anaesthesia, the mean arterial pressure (MAP) in unmedicated SH control rats was maintained at a relatively high level (16.2 +/- 0.7 kPa, mean +/- s.e. mean), while in captopril-treated rats MAP decreased to 8.8 +/- 1.1 kPa. Indomethacin somewhat inhibited MAP decrease in the captopril-medicated group. Saralasin infusion in halothane-anaesthetized rats decreased MAP in the same way as captopril alone. The tolerance to haemorrhagic shock was markedly impaired in rats receiving captopril or saralasin, compared to untreated controls. During halothane anaesthesia, the plasma renin activities in the captopril, captopril + indomethacin, and saralasin groups were significantly higher than in untreated animals. Plasma kininogen was unaffected by any of the medications. The results suggest that the renin-angiotensin system is important in maintaining blood pressure in halothane anaesthesia, and that the tolerance to haemorrhagic shock is particularly impaired by drugs inhibiting the renin-angiotensin system.

Hormonal responses to acute volume changes in anephric subjects

The response of plasma aldosterone and cortisol concentrations to acute volume depletion was studied in 18 chronically anephric subjects and four recently nephrectomized subjects. Volume-depleting hemodialysis and hemodialysis without volume depletion produced insignificant changes in plasma aldosterone concentrations in chronically anephric subjects. Failure of volume depletion to increase plasma aldosterone concentrations in these subjects could not be attributed to reductions in plasma potassium concentrations and was in marked contrast to the effect on plasma cortisol concentrations, which increased significantly during volume depletion. Changes in plasma cortisol concentrations exhibited a negative correlation with changes in diastolic blood pressure (r = -0.712, P less than 0.001) and were shown to correspond to similar changes in plasma ACTH concentrations. Comparable increases in plasma cortisol and ACTH concentrations were also demonstrated in the studies on recently nephrectomized subjects, who, in contrast to chronically anephric subjects, exhibited increases in plasma aldosterone concentrations which were concordant with the changes in plasma cortisol and ACTH concentrations. These findings suggest that plasma aldosterone concentrations are regulated by a volume-sensitive mechanism in recently nephrectomized subjects but not in chronically anephric subjects. We interpret these data as evidence of aldosterone responsiveness to ACTH that persists for a limited time only after removal of the stimulus provided by the renin-angiotensin system. Volume-related changes in plasma cortisol and ACTH concentrations occur in the absence of stimulation by a functioning renin-angiotensin system.

Centrally mediated enhancement of ouabain cardiotoxicity by angiotensin II in dogs

The effect of angiotensin II (Ang II) infusion on the doses of ouabain required to induce ventricular arrhythmias and death was investigated in anesthetized dogs. Tritiated ouabain was infused alone i.v. (1 microgram/kg per min) to establish the control toxic doses and the level of ouabain in the heart at death. When Ang II and ouabain were co-infused i.v. the doses of ouabain needed to induce arrhythmias and death were significantly reduced. Spinal transections performed at C-1 prior to drug infusions prevented the effect of Ang II to enhance the toxicity of ouabain. Thus, the action of Ang II to augment ouabain toxicity appeared to be related to its effects on the sympathetic nervous system. To confirm that Ang II was acting within the brain rather than at peripheral sites of the sympathetic system, Ang II was infused into the vertebral artery of spinal cord intact dogs. The infusion rate of Ang II needed to produce a significant enhancement of ouabain toxicity was much lower when given into the vertebral artery than into the femoral vein. These data indicate that Ang II enhances the cardiotoxicity of ouabain via an action produced within the brain and mediated by the sympathetic nervous system.

Action of L-epinephrine on the renin-aldosterone system and on urinary electrolyte excretion in man

The effect of L-epinephrine infusions (0.5-6.5 micrograms/min for up to 24 hr) in recumbency, on the renin-aldosterone system was studied in normal volunteers on diets containing 200 mEq sodium. Urinary sodium excretion was increased, potassium excretion was decreased, aldosterone excretion was suppressed while blood pressure and heart rate were minimally affected by epinephrine (1 microgram/min). Inulin and para-aminohippurate clearances changed transiently and slightly during epinephrine infusions over 10 hr in normal subjects. In separate experiments, epinephrine lowered serum K, raised serum Na, raised plasma renin activity and, usually lowered plasma aldosterone concentrations. There was an excellent correlation between epinephrine-induced changes in serum K and plasma aldosterone concentrations (r = +0.85, p less than 0.001). Significant dose-response relationships were found between L-epinephrine infusion rates of 0.5-6.5 micrograms/min and observed serum K concentrations. We conclude that L-epinephrine infusions at rates probably well within the physiological range, induce hypokalemia (by increased cellular uptake of K) which lowers aldosterone secretion depsite concomitant elevation of PRA and causes natriuresis for up to 24 hr.

Renal preservation resistance: evidence against myogenic vasoactive factors

Vasoconstriction is believed to be a dominant cause of high perfusion resistance during kidney preservation at low temperatures. An experiment was performed to study the effects of hypothermia on vasoactivity. Measurements were made on an apparatus that permitted perfusion resistance to be compared simultaneously in two isolated kidneys at different temperatures. With perfusion temperature serving as the variable, the vascular responses to several vasoactive agents were measured. Hypothermia diminished or altered the vascular responses to the agents. For example, no vasoconstriction was observed with Angiotensin II, dopamine, acetylcholine, or BaCl2 and no vasodilation was observed with papaverine or bradykinin in the hypothermic kidney. A significantly altered response was observed with norepinephrine. The responses were reversible upon return to normothermia. From these data, we conclude that myogenic vasoconstriction plays a questionable role in producing the elevated perfusion resistance observed in some hypothermic kidneys.

Effect of angiotensin-converting enzyme inhibitor (SQ 20881) on the plasma concentration of angiotensin I, angiotensin II, and arginine vasopressin in the dog during hemorrhagic shock

The effect of an angiotensin-converting enzyme inhibitor on the circulating levels of angiotensin I, angiotensin II, and arginine vasopressin was studied in dogs subjected to hypotensive hemorrhagic shock. In dogs subjected to hemorrhage but not given the inhibitor, angiotensin II rose 20-fold (from 69 to 1,343 pg/ml of plasma), whereas in dogs subjected to hemorrhage but pretreated with the inhibitor, angiotensin II rose only 2-fold (from 92 to 171 pg/ml of plasma). In the pretreated dogs angiotensin I rose 30-fold (from 108 to 3,232 pg/ml of plasma). There was no statistically significant difference between the vasopressin levels found in the untreated dogs and the levels found in dogs given the inhibitor (1,016 and 1,095 pg/ml of plasma). Of the 15 dogs in the untreated group, five died before retransfusion was completed (four of cardiac failure and one of cardiac arrhythmia); none of the 10 dogs in the inhibitor-treated group died. These observations suggest that the very high levels of angiotensin II observed following severe hemorrhage do not contribute significantly to the increased secretion of vasopressin and that the inhibitor protects against death, possibly by suppressing the very high blood levels of angiotensin II observed following this type of experimental hemorrhagic shock.

On the role of calcium as second messenger in liver for the hormonally induced activation of glycogen phosphorylase

We have studied the mode of action of three hormones (angiotensin, vasopressin and phenylephrine, an alpha-adrenergic agent) which promote liver glycogenolysis in a cyclic AMP-independent way, in comparison with that of glucagon, which is known to act essentially via cyclic AMP. The following observations were made using isolated rat hepatocytes: (a) In the normal Krebs-Henseleit bicarbonate medium, the hormones activated glycogen phosphorylase (EC 2.4.1.1) to about the same degree. In contrast to glucagon, the cyclic AMP-independent hormones did not activate either protein kinase (EC 2.7.1.37) or phosphorylase b kinase (EC 2.7.1.38). (b) The absence of Ca2+ from the incubation medium prevented the activation of glycogen phosphorylase by the cyclic AMP-independent agents and slowed down that induced by glucagon. (c) The ionophore A 23187 produced the same degree of activation of glycogen phosphorylase, provided that Ca2+ was present in the incubation medium. (d) Glucagon, cyclic AMP and three cyclic AMP-dependent hormones caused an enhanced uptake of 45Ca; it was verified that concentrations of angiotensin and of vasopressin known to occur in haemorrhagic conditions were able to produce phosphorylase activation and stimulate 45Ca uptake. (e) Appropriate antagonists (i.e. phentolamine against phenylephrine and an angiotensin analogue against angiotensin) prevented both the enhanced 45Ca uptake and the phosphorylase activation. We interpret our data in favour of a role of calcium (1) as the second messenger in liver for the three cyclic AMP-independent glycogenolytic hormones and (2) as an additional messenger for glucagon which, via cyclic AMP, will make calcium available to the cytoplasm either from extracellular or from intracellular pools. The target enzyme for Ca2+ is most probably phosphorylase b kinase.

Glycogen phosphorylase, glucose output and vasoconstriction in the perfused rat liver. Concentration-dependence of actions of adrenaline, vasopressin and angiotensin II

1. Glycogen phosphorylase (a form, in rapidly freeze-clamped samples) and glucose release were measured in the perfused liver, in response to a range of concentrations of adrenaline, [8-arginine]vasopressin (anti-diuretic hormone) and angiotensin II. 2. All three hormones increased phosphorylase a activity by about 10 mumol/min per g of fresh liver, which was more than sufficient to explain concomitant glucose release (1-2mumol/min per g). 3. Minimally effective concentrations which activated phosphorylase were: adrenaline, 10nM (2ng/ml); vasopressin, 40pM (40pg/ml, 15 muunits/ml); angiotensin II, 60pM (60pg/ml). 4. Glycogen synthase activity was inhibited by adrenaline and vasopressin but not significantly by angiotensin II. 5. Vasoconstriction observed with adrenaline and angiotensin II (but not vasopressin) might explain part of the activation of phosphorylase, since equivalent vasoconstriction (in separate perfusions) activated phosphorylase, did not stimulate glucose output or inhibit synthase. 6. The potency of these effects suggests that all three hormones can stimulate hepatic glycogen degradation in vivo (by direct hepatic action). It is proposed that hormones, and ischaemia, stimulate glycogen degradation to provide glucose phosphates for disposal within the liver cell, as well as for release as free gluose.

Effect of vasoactive agents on the distribution of renal cortical blood flow in dogs

The distribution of renal cortical blood flow was studied in 6 Nembutal anesthetized dogs during control periods and during infusions of adrenaline, noradrenaline, angiotensin and vasopressin. Local cortical blood flow was measured as H2 gas desaturation rate recorded polarographically by platinum electrodes in outer and inner cortex. The total renal blood flow (RBF) was measured by an electromagnetic flow meter. In the control period the outer cortical blood flow (OCF) and inner cortical blood flow (ICF) averaged 3.59 (+/- S.D. 0.85) ml/min - g and 3.23 (+/- S.D. 0.64) ml/min - g, respectively. Infusions of the various vasoactive agents caused essentially equal vascular responses. All agents caused increased local renal resistance and reduction of RBF whether given intravenously or intraarterially. The RBF could be lowered to 20-50% of initial control flow by increasing doses of vasoactive agents. OCF and ICF fell proportionately and almost to the same extent as RBF, or OCF fell slightly more than ICF. There was no evidence for patchy or zonal hypoperfusion in cortex caused by infusion of adrenaline, noradrenaline, angiotensin and vasopressin.

Graded levels of hemorrhage, thirst and angiotensin II in the rat

Hemorrhage was evaluated as a stimulus to drink in rats prepared with chronically implanted jugular cannulae and bled either 20, 30, 40 or 50 percent of their total blood volume. Hourly observations of water intake for 5 hr after hemorrhage revealed that the volume drunk was proportional to the degree of hemorrhage. Drinking induced by 20 percent hemorrhage did not differ significantly from control values, and intake was greatest and most persistent after 50 percent blood loss. The onset of maximal drinking at 1 hr after 40 percent hemorrhage was preceded by a twofold increase in plasma concentrations of angiotensin II. This is compatible with previous suggestions that angiotensin plays a role in hypovolemic thirst.

Angiotensin- and norepinephrine-induced myocardial lesions: experimental and clinical studies in rabbits and man

The ability of large doses of exogenous angiotensin II to cause widespread multifocal microscopic myocardial necrosis in the rabbit has been confirmed. Angiotensin II also consistently produced acute renal failure with, less consistently, renal tubular necrosis. Norepinephrine infusions caused histologically indistinguishable myocardial lesions, but did not detectably affect renal function or histology. Severe renal failure, induced by bilateral nephrectomy (with or without concurrent glycerol administration) was not associated with similar cardiac lesions. Acute renal failure of comparable or greater severity to that induced by angiotensin II was produced by intramuscular cephaloridine, and was not associated with cardiac lesions. Rabbits infused with saline intravenously or "sham"-operated by simply opening and closing the peritoneal cavity did not develop renal failure and showed no cardiac or renal lesions histologically. Myocardial lesions, apparently identical to those seen in the rabbits, were observed postmortem in three patients known to have had high circulating levels of angiotensin II before death, although in all three cases alternative explanations are possible. Unexplained arrhythmia, cardiac arrest, and central chest pain without clear cardiographic or serum enzyme evidence of myocardial infarction occurred in two other subjects with very high plasma levels of angiotensin II. These attacks ceased after bilateral nephrectomy and a consequent fall in plasma angiotensin II. The cardiac attacks in these five patients all occurred during or shortly after procedures, such as sodium-depleting dialysis, renal artery surgery, or diazoxide administration, known to cause increase in plasma concentrations of renin and angiotensin II.

On the role of vasopressin and angiotensin in the development of irreversible haemorrhagic shock

1. Long-lasting haemorrhagic hypotension (4.5 hr at 35 mmHg) leading to irreversible haemorrhagic shock, has been studied in normal dogs, in dogs treated with a bradykinin potentiating nonapeptide (BPP(9a)), which blocks the conversion of angiotensin I to angiotensin II, and in dogs with experimental chronic diabetes insipidus (DI dogs). BPP(9a) was given by I.V. injection before the start of bleeding (BPP pre-treated group), 45 min after blood pressure had reached 35 mmHg (BPP early treated group) or 2 hr after blood pressure had reached 35 mmHg (BPP late-treated group). After retransfusion of blood all dogs were allowed to recover and observed for a further period of 3 days.2. Untreated control dogs developed haemorrhagic shock with tachycardia, low cardiac output, low total peripheral conductance and low stroke volume. All died within 24 hr of retransfusion, with pathological lesions typical of irreversible haemorrhagic shock.3. BPP pre-treated dogs developed haemorrhagic shock with bradycardia (during early shock), high cardiac output, high peripheral vascular conductance and high stroke volume when compared with the untreated controls. All pre-treated animals survived the 3 day observation period. They were then killed and on post-mortem showed no signs of irreversible haemorrhagic shock.4. BPP early-treated animals behaved like controls before BPP, but like pre-treated animals after the drug. Only one out of eight died within the 3 day observation period.5. BPP late-treated dogs behaved like controls before BPP. They responded to the drug with a rise in cardiac output, peripheral vascular conductance and stroke volume, and with a fall in heart rate. These responses were, however, short-lived. Four out of these eight animals died within the 3 day observation period, with lesions of irreversible haemorrhagic shock.6. DI dogs developed haemorrhagic shock with tachycardia (like controls), but with high cardiac output and peripheral vascular conductance (like BPP pre-treated dogs). The stroke volume of DI dogs was intermediate between those of controls and pre-treated groups. All six dogs survived the 3 day observation period.7. BPP(9a) had no measurable effect on the course of endotoxic shock.8. It is suggested that the normally severe vasoconstriction of the mesenteric vascular bed, which is thought to be responsible for irreversible haemorrhagic shock, is absent or attenuated in the absence of vasopressin or angiotensin. The consequences of this on the development of irreversibility are discussed.

Profile of circulating vasoactive substances in hemorrhagic shock and their pharmacologic manipulation

(a) Hemorrhage in dogs (to 45-50 mm Hg) was associated with a 10-fold increase in plasma renin activity (PRA) which remained elevated throughout the time-course of shock including the irreversible (decompensation) stage. The presence of angiotensin II (AII) in arterial blood was demonstrated by the bloodbathed organ technique and confirmed by blockade with specific AII antagonists (cysteine(8)-AII or isoleucine(8)-AII). The contribution of AII to systemic peripheral resistance during hemorrhage shock in dogs was established by administering AII antagonists which immediately cause a further fall in blood pressure.(b) Plasma catecholamines (CA) steadily increased during hemorrhage and peaked during compensation (a 100-fold increase). The CA decreased progressively during decompensation.(c) Prostaglandin (PG) E-like material was observed in arterial blood for 15-60 min (after hemorrhage); the peak arterial concentration was 2.6 ng/ml blood. Indomethacin (i.v., before 80% of maximum bleedout): (i) confirmed the presence of PGE, (ii) increased blood pressure, and (iii) increased blood loss.(d) Thus: peripheral resistance during hemorrhagic shock seems temporally correlated with blood CA levels (and not PRA), and the renin-AII system contributes to the maintenance of vascular resistance and may markedly decrease perfusion of organs, such as kidney; the administration of the proper combination of specific antagonists of vasoconstrictor humoral substances may radically improve organ perfusion and could contribute to ultimate recovery from hemorrhagic shock.

Mechanism of the redistribution of renal cortical blood flow during hemorrhagic hypotension in the dog

Studies were performed to define the mechanisms involved in the redistribution of renal cortical blood flow to inner cortical nephrons which occurs during hemorrhagic hypotension in the dog. The radioactive microsphere method was utilized to measure regional blood flow in the renal cortex. Renal nerve stimulation decreased renal blood flow 40% but had no effect on the fractional distribution of cortical blood flow. Pretreatment with phenoxybenzamine, phentolamine, propranolol, or atropine did not alter the redistribution of cortical flow during hemorrhage. A reduction in renal perfusion pressure by aortic constriction caused a qualitatively similar alteration in regional blood flow distribution as occurred during hemorrhage. When perfusion pressure was kept constant in one kidney by aortic constriction followed by hemorrhage, no redistribution occurred in the kidney with a constant perfusion pressure while the contralateral kidney with the normal perfusion pressure before hemorrhage had a marked increase in the fractional distribution of cortical flow to inner cortical nephrons. Additionally, retransfusion had no effect on the fractional distribution of flow in the kidney in which perfusion pressure was maintained at the same level as during hemorrhage while in the contralateral kidney in which pressure increased to normal there was a redistribution of flow to outer cortical nephrons. These studies indicate that the redistribution of renal cortical blood flow which occurs during hemorrhage is not related to changes in adrenergic activity but rather to the intrarenal alterations which attend a diminution in perfusion pressure.

Relationship between renin and intrarenal hemodynamics in hemorrhagic hypotension

In order to investigate the possible role of the renin-angiotensin system in the regulation of intrarenal hemodynamics in hemorrhagic hypotension (HH), seven mongrel dogs have been studied under the following conditions: (a) Control, (b) HH (mean arterial pressure 70 mm Hg), and (c) HH + alpha adrenergic blockade by phenoxybenzamine (HH + POB). The following parameters were obtained for the right kidney: Intrarenal distribution of blood flow and local blood flow rates ((133)Xe washout technique); total renal blood flow (RBF) on the basis of the clearance and extraction ratio of PAH and the arterial hematocrit; plasma renin concentrations in the renal artery and vein by the method of Boucher and his associates; and renin release into the renal circulation. Alpha adrenergic blockade reverted the typical redistribution of intrarenal blood flow observed under HH. In hemorrhage, arterial and venous renin concentrations increased by a factor of 3.4 and 4.8 respectively. A further small increase was observed during HH + POB with the respective factors increasing to 4.8 and 5.3, as compared with control values. The renin release into the circulation increased by a factor of 1.2 in HH and 4.0 in HH + POB. Whereas in HH there seemed to be a relationship between increased renin concentrations or renin release, and the redistribution of blood flow, no such correlation was found during alpha-adrenergic blockade. From these observations it is concluded that renin alone is unable to maintain the typical redistribution of RBF seen during hemorrhage. Circumstantial evidence points to a permissive role of the renin-angiotensin system in the pathogenesis of the patchy cortical hypoperfusion caused by sympathoadrenergic mechanisms during hemorrhagic hypotension.

Effect of retransfusion after hemorrhagic hypotension on intrarenal distribution of blood flow in dogs

Hemorrhagic hypotension in anesthetized dogs produces a marked decrease of the cortical blood flow, whereas the medullary blood flow is well preserved. These animals were maintained at blood pressures of 50 mm Hg during a 3 hr period after which their blood pressures were restored by the reinfusion of blood or dextran, or both. In the first group of animals, the reinfusion of blood reestablished the blood pressure to control values, but the cortical blood flow was still nonuniformly decreased whereas the medullary blood flow appeared to be increased. In the second group of animals, phenoxybenzamine failed to protect the kidney completely since after blood reinfusion, the same anomalies described for the preceding group were found in 7 out of 10 dogs. The animals of the third group were reinfused with 50% of the shed blood and 10 ml/kg of a 10 g/100 ml solution of low molecular weight dextran. The modifications of the intrarenal distribution of the blood flow were less marked in this group although the blood flow rate of the inner cortex and the outer medulla was always elevated under these conditions. The reinfusion of low molecular weight dextran alone (20 ml/kg of a 10 g/100 ml solution) restored the blood pressure to levels slightly lower than those observed under control conditions but reestablished a normal pattern of intrarenal blood flow. The reinfusion of high molecular weight dextran was inefficient in correcting completely the anomalies of the renal blood flow. Mechanisms such as the increased sympathetic tone, the liberation of angiotensin, and the intravascular cellular aggregation could possibly account for the persisting anomalies of the renal circulation after reinfusion and are discussed.

The control of aldosterone secretion and its relationship to the diagnosis of hyperaldosteronism

Current concepts of the control of aldosterone secretion in man have been reviewed with particular reference to the role of the kidney. On the basis of these concepts, it is concluded that hyperaldosteronism is most conveniently diagnosed by repeated estimation of plasma potassium, which is usually persistently or intermittently reduced in this disease. Occasional cases fail to show hypokalaemia. Distinction between primary and secondary hyperaldosteronism is made by means of measurement of plasma renin concentration. Subnormal values are usually obtained in the first instance and supranormal values in the second.

Effect of hemorrhage and retransfusion on intrarenal distribution of blood flow in dogs

Distribution of intrarenal blood flow was studied in 12 dogs anesthetized with Nembutal. Medullary blood flow was estimated by local clearance of hydrogen gas from the outer medulla measured polarographically with needleshaped platinum electrodes, and by local clearance of (85)Kr and mean transit time of (32)P-labeled erythrocytes measured with a small semiconductor detector placed in the outer medulla. Cortical blood flow was estimated from cortical red cell transit time and from total renal blood flow measured by electromagnetic flowmeter. Bleeding to a mean arterial pressure of 50-65 mm Hg in the course of 8-20 min reduced cortical and medullary blood flow on the average to the same extent. In half of the experiments both cortical and medullary blood flow were reduced proportionately less than mean arterial pressure during the first half hour of bleeding. Maintenance of mean arterial pressure at 50-65 mm Hg in all cases led to progressive reduction of both cortical and medullary blood flow, out of proportion to the reduction of arterial pressure. A two step bleeding procedure used in two experiments also led to uniform reduction of renal blood flow. Reinfusion of blood after 2-3 hr of hypotension increased total renal blood flow to an average of 82% and outer medullary hydrogen clearance to an average of 92% of control values. All dogs survived the experiment without evidence of renal failure. It is concluded that hemorrhagic hypotension in dogs leads to a progressive and fairly uniform rise in renal vascular resistance, without any selective hemodynamic response in the juxtamedullary circulation.

Role of the autonomic nervous system in the renal vasoconstriction response to hemorrhage in the rabbit

In normal unanesthetized rabbits with intact autonomic effectors, rapid removal of 26% of the blood volume resulted in prolonged renal vasoconstriction. This response was completely absent in rabbits without functioning autonomic effectors (after guanethidine treatment + adrenalectomy + atropine), despite the greater arterial hypotension in this group. The effects of removing 26% and 32% of the blood volume were compared in the normal innervated and chronically surgically denervated kidney of the same animal. After 26% hemorrhage, the vessels of both kidneys constricted, but the response was significantly greater on the innervated side; reduction in GFR was the same in both kidneys. After 32% hemorrhage the renal constrictor response was greater than after 26% hemorrhage, the difference largely resulting from additional humoral effects, as estimated by the greater vasoconstriction observed in the hypersensitive surgically denervated kidney at this level of hemorrhage; GFR also fell more on the denervated side. The results indicate that sympatho-adrenal activity is essential in the production of renal vasoconstriction after hemorrhage, and suggest that this response is normally produced by the synergistic action of increased sympathetic nerve activity and humoral effects, including those of the adrenal catecholamines.

Effect of hemorrhage on arterial plasma renin activity in the rabbit

Arterial plasma renin activity in the rabbit was measured at the beginning and end of a brisk hemorrhage and 40 min later. Activity rose to a mean of two and one-half times the control value during the hemorrhage, and was five times greater than the control 40 min later. The rise in plasma renin activity was not due to anesthesia, as light pentobarbitone produced no change. Conscious rabbits, severely bled from a carotid cannula, 2 to 5 hr after an ether anesthetic, also showed an increase in plasma renin activity at the end of hemorrhage. Forty-eight hours after both kidneys had been removed, renin activity was virtually absent and did not rise after hemorrhage.

The continuous estimation of angiotensin formed in the circulation of the dog

1. The use of the rat colon as a blood-bathed organ is described for detecting changes in angiotensin concentration in the circulating blood of dogs.2. Partial occlusion of the aorta by a balloon inflated above the renal arteries leads to a contraction of the blood-bathed rat colon.3. From the experimental evidence, it is concluded that this contraction is due to an increased concentration of circulating angiotensin, brought about by the liberation of renin from the kidneys.4. The characteristics of renin release have been studied. It occurs within seconds of reducing the blood pressure to the kidneys and is proportional to the degree of reduction of blood pressure.5. With a prolonged reduction of renal blood pressure the concentration of angiotensin increases over the first 10-12 min and then reaches a stable level.6. After a small haemorrhage angiotensin often appears in the circulation without a concomitant release of catechol amines.7. Greater haemorrhages induce the secretion of catechol amines as well as of renin. The catechol amine secretion is inhibited by ganglion block, but the renin secretion is not.8. It is concluded that the secretion of renin by the kidneys in response to a fall of renal blood pressure is a physiological response, probably of importance in homoeostasis.

The effect of acute haemorrhage in the dog and man on plasma-renin concentration

1. The effect of acute haemorrhage on the plasma renin concentration was studied in the dog and man.2. Plasma-renin concentration was regularly increased after the larger bleeds; after the smaller haemorrhages plasma-renin concentration remained unchanged.3. The results are discussed in relation to current hypotheses concerning the control of renin and aldosterone secretion.