Renal mechanisms in heart failure

The clinically most obvious response to cardiac failure is the formation of edema on the basis of fluid and sodium retention by the kidney. This phenomenon, which up to a point subserves the restoration of cardiac performance, often overshoots its apparent teleological purpose. The mechanisms are partly simple (determined by hydraulics and haemodynamics), partly complex, involving a host of neurohumoral ancillary systems. The present review attempts to put some of the phenomena related to renal function in congestive heart failure into perspective. The time does not yet appear to be ripe for a complete picture or unifying concept, there being a need for more quantitative and comparative data on the roles of ancillary hormonal systems in different stages of congestive heart failure.