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The effects of low dose intravenous 99-126 atrial natriuretic factor infusion in patients with chronic renal failure
A S Woolf1, M A Mansell, B I Hoffbrand
1Academic Unit of Endocrinology and Diabetes, Whittington Hospital, London, UK.
Insights
Atrial natriuretic factor (ANF) infusion improved sodium excretion in chronic renal failure patients. However, ANF also increased albuminuria, potentially harming long-term kidney function.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Physiology
Background:
- Chronic renal failure (CRF) is associated with complex hormonal dysregulation.
- Atrial natriuretic factor (ANF) plays a role in fluid and electrolyte balance.
- The specific effects of ANF in non-dialyzed CRF patients require further elucidation.
Purpose of the Study:
- To investigate the renal and hormonal impacts of intravenous ANF infusion.
- To assess ANF's effect on sodium and albumin excretion in CRF.
- To evaluate the physiological consequences of elevated ANF levels in renal impairment.
Main Methods:
- Intravenous infusion of synthetic ANF (99-126) in patients with moderate to severe CRF.
- Measurement of plasma and urinary cyclic guanosine monophosphate (cGMP) as a marker of ANF activity.
- Comparison of sodium and albumin excretion rates between ANF and placebo groups.
Main Results:
- ANF infusion significantly increased sodium excretion by 68% compared to a 40% decrease in the placebo group.
- Plasma and urinary cGMP levels rose, confirming ANF's tissue-level effects.
- Significant increases in urinary albumin excretion were observed during ANF infusion.
Conclusions:
- Elevated plasma ANF levels in CRF may contribute to maintaining sodium balance.
- The observed increase in albuminuria suggests a potential detrimental effect of ANF on long-term renal function.
- Further research is needed to understand the therapeutic window and risks of ANF in renal disease.
Abstract:
The aim was to study the renal and hormonal effects of intravenous 99-126 atrial natriuretic factor (ANF) infusion in a mixed group of patients who had moderate to severe chronic renal failure (CRF) and who were not treated with dialysis. The peak mean plasma level of ANF achieved during the experiment was at the upper limit of an absolute range of basal values previously recorded in a larger group of patients with similar degrees of renal impairment. A significant tissue effect was confirmed by rises in plasma and urinary cyclic guanosine monophosphate, the 'second-messenger' of ANF. ANF infusion increased sodium excretion rate by a mean of 68% compared with a fall of 40% in a placebo group, and significant increases in urinary albumin excretion occurred during the peptide infusion. Thus, the high levels of plasma ANF found in CRF may have a role in the maintenance of sodium balance. In addition, the proteinuric effect may be detrimental to long-term renal function.
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