Metabolic observations on salt wasting in a patient with renal disease

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      A case of salt-wasting renal disease is presented, the outstanding features being advanced renal insufficiency, polyuria, normal blood pressure and Addisonian-like skin pigmentation. Sodium intakes varying between 250 and 300 mEq. per day were required to maintain sodium balance and to stabilize renal function. A much greater tendency to “waste” sodium chloride than sodium bicarbonate was demonstrated, the urinary sodium loss being composed almost exclusively of sodium chloride. Studies of aldosterone secretory rate during periods of low and high sodium intake revealed a persistently increased aldosterone secretion rate, with a striking rise in response to relatively mild salt restriction. The results of balance studies appear to be best explained by postulating glomerulotubular imbalance with associated difficulty in the reabsorption of sodium chloride and severe secondary hyperaldosteronism.
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