The renal dopaminergic system, neurohumoral activation, and sodium handling in heart failure

• Tipo: Artigo em Revista Científica Internacional
• Data: 2002

Autores

Ferreira A (Autor) FMUP; Bettencourt P (Autor) FMUP; Pimenta J (Autor) Outra; Friões F (Autor) FMUP; Pestana M (Autor) FMUP; soares-da-silva, p (Autor) FMUP; Cerqueira Gomes, M (Autor) Outra

Revista

Título: American Heart Journal

Vol. 143

Páginas: 391-397

ISSN: 0002-8703

Editora: Elsevier

Indexação

ISI Web of Knowledge - 12 Citações

Scopus - 17 Citações

Outras Informações

ID Authenticus: P-000-Q1Y

DOI: 10.1067/mhj.2002.120292

Abstract (EN): Background Dopamine of renal origin exerts natriuretic and diuretic actions by activating specific receptors located in the renal proximal tubular epithelial cells, Heart Failure (HF) is accompanied by activation of several neurohumoral systems. The interaction of these systems with the renal dopaminergic system and its effect on sodium handling in HF are not clarified. Methods and Results We studied 13 patients with decompensated New York Heart Association class III/IV HF and 17 sex- and age-matched patients with mild to moderate stable class I/II HF. We measured plasma catecholamines, aldosterone, type B natriuretic peptide (BNP), sodium, creatinine (UCr), and 24-hour urinary excretion of sodium, UCr, levo-3,4-dihydroxyphenylalanine (L-DOPA), 3-o-methyldopa, dopamine and its metabolites, 3,4-dihydroxyphenylacetic acid and homovallinic acid, and norepinephrine. All patients had HF of ischemic etiology. No statistically significant differences were found between the groups with respect to urine volume (1.79 +/- 0.23 L - d(-1) vs 2.20 +/- 0.18 L. d(-1), P =.18) and urinary sodium (161.3 +/- 27.5 mmol . d(-1) vs 232.9 +/- 28.8 mmol . d(-1), P = .12). Urinary L-DOPA was significantly lower in patients with decompensated class III/IV HF than in the other group (79.0 +/- 13.8 nmol . g UCr(-1) vs 108.4 +/- 10.3 nmol . g UCr(-1), P =.04). Urinary doparnine showed a nonstatistically significant trend to be slightly higher ( 1294.3 +/- 188.5 nmol . g UCr(-1) 953.2 +/- 107.4 nmol . g UCr(-1), P =.14). Consequently, urinary dopamine/L-DOPA ratios were markedly higher in patients with decompensated class III/IV HF than in the other patients (20.6 +/- 3.4 vs 9.0 +/- 0.9, P <.00 1). Plasma L-DOPA (38.1 +/- 4.4 pmol . mL(-1) vs 40.0 +/- 3.0 pmol . mL(-1), P=.48), dopamine (37.0 +/- 6.3 pmol . mL(-1) vs 41.1 +/- 2.6 pmol . mL(-1), P =.53), 3,4-dihydroxyphenylacetic acid (5 1.7 +/- 1 1.7 pmol . mL(-1) vs 56.5 +/- 5.4 pmol . mL(-1), P =.09), and norepinephrine (9.5 +/- 2.4 pmol . mL(-1) vs 5.6 +/- 1.0 pmol . mL(-1), P =.12) did not cliff er between groups. Plasma alclosterone (180.2 +/- 28.0 pg . mL(-1) vs 69.9 +/- 13.3 pg . mL(-1), P <.001) and BNP (677.5 +/- 133.9 pg . mL(-1) vs 389.4 +/- 88.4 pg . mL(-1), P <.04) levels were higher in the decompensated class III/IV HF group than in the other group, whereas serum sodium was lower (137.3 +/- 1.2 mmol . L(-1) vs 143.2 +/- 1.0 mmol . L(-1), P =.00 1). Conclusions These results suggest that, in patients with HF, the increased renal utilization of L-DOPA may constitute a compensatory mechanism, activated in response to stimuli leading to sodium reabsorption.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 7