Figure 28

A, The relationship between renal artery perfusion pressure and sodium excretion (which defines "pressure natriuresis") has been the subject of extensive research. Essential hypertension is characterized by higher renal perfusion pressures required to achieve daily sodium balance. B, Distortion of this relationship routinely occurs in patients with parenchymal renal disease, illustrated here as "loss of renal mass." Similar effects are observed in conditions with disturbed hormonal effects on sodium excretion (aldos-terone-stimulated kidneys) or reduced renal blood flow as a result of an arterial stenosis ("Goldblatt" kidneys). In all of these instances, higher arterial pressures are required to maintain sodium balance.

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