Renal response to systemic trauma

Volume replacement will generally correct hypotension and prevent the sequence of events described herein. When inadequate volume replacement has occurred or been delayed or globin pigments are present, the use of mannitol or ganglionic blocking agents such as isoproterenol may be useful not only to block the further release of renin but also to decrease renal vascular resistance. Attempts to increase tubular urine flow are generally successful when adequate quantities of a balanced electrolyte solution are administered, especially if this can be carried out prior to the development of high levels of circulating plasma aldosterone. If this is not effective, the concentration of sodium in the distal tubule can be increased by the use of mannitol, which apparently acts by blocking systemic renin release and results in increased perfusion of the renal medulla. This hypothesis provides a logical explanation for the clinical effectiveness of apparently unrelated pharmocologic and physiologic maneuvers including the use of large volumes of balanced electrolyte solution and the use of an osmotic diuretic and ganlionic blocking agent. All of these act to inhibit renin release from the kidney. (Figure 3.) Experimental data are necessary to verify the role of renin in the pathogenesis of acute renal failure. The present hypothesis may serve as a framework for further study.