Idiopathic edema: II. Pathogenesis of edema in patients with hypoalbuminemia

Abstract

Patients with idiopathic edema, previously shown to have a significantly subnormal total circulating albumin level and a significantly subnormal plasma volume, were found to have abnormally large amounts of the neurohumoral transmitter norepinephrine in the urine, an abnormally high plasma renin activity when supine which increased still further when they assumed the upright posture, and hypersecretion of aldosterone. The subnormal plasma volume and the increase in adrenergic activity apparently produced thereby, presumably increased plasma renin activity and, in turn, the secretion of aldosterone. An increase in adrenergic discharge to the kidney and an increase in circulating aldosterone can both increase the reabsorption of sodium by the renal tubules and could therefore be the basis for the excessive sodium retention and edema which is characteristic of these patients.