Studies on the metabolism of aldosterone in chronic renal failure and anephric man

Abstract

Studies on anephric man and patients with chronic renal failure were undertaken to investigate the role of the kidneys in the control of aldosterone secretion. Volume depletion produced by isonatremic, isokalemic volume depletion did not result in increased plasma aldosterone concentrations in anephric man. ACTH and angiotensin II infusion and postural change also failed to stimulate aldosterone production in these subjects. Patients with chronic renal failure, but with kidneys and receiving hemodialysis, usually failed to respond to ACTH or to postural change. Volume depletion, upright posture and other direct stimuli of aldosterone secretion did not have a significant effect in anephric patients. Since most patients with chronic renal failure on hemodialysis also demonstrated blunted responses in contrast to those not on hemodialysis, some aspect of the dialysis process itself may have interfered with the adrenal response to acute stimulation. From these studies, it was not possible to delineate whether the renin angiotensin system plays a permissive or dominant role in regulation of aldosterone secretion in man.