Renal response to arginine vasopressin in premature infants with late hyponatraemia

To assess the influence of late hyponatraemia on the renal responsiveness to endogenous arginine vasopressin (AVP), urinary excretion and plasma concentration of sodium, plasma and urine osmolality, free water clearance, and urinary AVP concentration and excretion were measured in 11 healthy premature infants with a mean birth weight of 1360 g and mean gestational age of 31 weeks. Studies were performed on days 1, 5, and 19. The development of late hyponatraemia was associated with a pronounced decline in urine osmolality, whereas urine flow rate and free water clearance increased significantly. Mean (SEM) urine AVP concentration and excretion also rose significantly from 2.15 (0.31) pg/ml and 0.36 (0.55) pg/min/m2 on the first day to 6.5 (0.96) pg/ml and 3.85 (0.63) pg/min/m2 on the 19th day, respectively. When renal response to AVP was compared at different ages the highest urine osmolality and steepest response curve was observed on the first day. With development of hyponatraemia the renal response became blunted. It is concluded that the limited tubular sodium transport and hyponatraemia hinders the establishment of intrarenal osmotic gradient, impairs renal response to AVP, and prevents excessive water retention and further fall of plasma sodium.