Mechanisms for the elevation of blood pressure in human renal disease. Preliminary report

Detailed hemodynamic studies were carried out in 99 subjects with chronic nonuremic renal disease and 17 healthy subjects. The earliest hemodynamic abnormality found in normotensive renal patients was a raised circulating blood volume and an increased cardiac output. The blood pressure remained normal as long as the peripheral vascular bed (arteriolar and venous) adjusted to these conditions. When this adjustment ceased, hypertension developed and the blood volume normalized. It is suggested that a disturbed volume-homeostatic function of the kidney, leading to a rise of the circulating blood volume, is the proper starter of hemodynamic events leading eventually to hypertension in chronic parenchymatous renal disease.