RENAL VENOUS PRESSURE IN CHRONIC CONGESTIVE HEART FAILURE 1

Abstract

In the recent literature there has been a revived interest in the role of the kidney in congestive heart failure, particularly with reference to the mechanism of sodium retention and edema formation (1-12). In view of the contention by Blake and his associates (13) that a rise in renal venous pressure in the dog may prevent excretion of sodium without altering renal blood flow or filtration rate as measured by clearance methods, and its possible implications in man, it was felt that actual measurement of renal venous pressure in subjects with con-gestive heart failure was indicated. A review of the literature revealed that there were no previous measurements of renal venous pressure in normal human subjects other than the six figures cited by Bradley and Bradley (14) who, for their purposes were more concerned with comparative pressures before and during abdominal compression than with a precise set of normal values. The purpose of this communication is 1) to establish a standard technique and set of normal values for renal venous pressure measurements in man, and 2) to report on renal venous pressure in patients with congestive heart failure, discussing the significance and the hemodynamic mechanisms involved. MATERIALS AND METHODS The control subjects were all patients in Bellevue Hospital with no evidence of cardiovascular or renal disease. Most of them had benign lesions, such as leg ulcers, or were convalescent and about to be discharged from the hospital. The subjects with congestive heart failure had such evidence of right-sided failure as ankle edema, distended liver, pulsating neck veins and increased peripheral venous pressure as measured on the ward; the degree of left-sided failure was variable.