Effects of atrial natriuretic peptide on distal tubule function in humans

To characterize the actions of atrial natriuretic peptide (ANP) in the human distal nephron, we studied interactions between ANP (0.02 micrograms/kg.min i.v.) and acutely administered substances acting in the distal nephron, that is, amiloride and aldosterone, in six healthy humans during maximal water diuresis. ANP increased NaCl excretion, fractional lithium excretion (FELi) and decreased diluting segment reabsorption estimated from free water clearance. Amiloride increased natriuresis, had no effect on FELi, but decreased diluting segment reabsorption. Aldosterone had the opposite effect. When infused in addition to amiloride, ANP still increased NaCl excretion, the changes in sodium handling parameters being comparable to those seen after ANP alone. Amiloride did not increase the further natriuretic response to ANP. These findings suggest that ANP increases distal sodium delivery, and decreases sodium reabsorption in distal segments by a mechanism also sensitive to amiloride. ANP abolished much of the antinatriuretic effect of aldosterone, which may also be explained by assuming a partial overlap of the target segments of ANP and aldosterone in the distal nephron. Remarkably, in neither of these experiments was the natriuresis after ANP accompanied by a kaliuresis, for which the explanation remains obscure.