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European Journal of Heart Failure 2002 4(5):597-603; doi:10.1016/S1388-9842(02)00097-1
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© 2002 European Society of Cardiology

Serum to urinary sodium concentration ratio is an estimate of plasma renin activity in congestive heart failure

GianCarlo Marenzi*, Gianfranco Lauri, Emilio Assanelli, Marco Grazi, Jeness Campodonico, Gabriella Famoso and Piergiuseppe Agostoni

Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan via Parea 4, 20138 Milan, Italy

* Corresponding author. Tel.: +39-02-580021; fax: +39-02-504667. E-mail address: giancarlo.marenzi{at}cardiologicomonzino.it


  Abstract

We investigated the relationship between plasma renin activity (PRA) and serum ([sNa+]) and urinary ([uNa+]) sodium concentrations in 124 congestive heart failure (CHF) patients (II–IV NYHA class) and 20 healthy subjects. According to PRA (> or <3 ng ml–1 h–1) and [sNa+] (> or <135 mEq l–1), patients were classified as Group A (normal PRA and normal [sNa+], n=39), Group B (increased PRA and normal [sNa+], n=62) and Group C (low [sNa+], n=23). Measurements were performed at rest and, in 26 cases, after extracorporeal ultrafiltration (UF). At rest, [sNa+] and [uNa+], and their difference ([sNa+]–[uNa+]), were linearly correlated with PRA, but the values did not allow differentiation of control subjects from patients or differentiation of patients with from those without renin–angiotensin system (RAS) activation. Conversely, the [sNa+]/[uNa+] ratio showed the best correlation with PRA (r=0.79, P<0.0001). UF-induced PRA changes were linearly correlated with [sNa+]/[uNa+] ratio changes (r=0.67, P=0.002), but not with those of [sNa+], [uNa+] and [sNa+]–[uNa+]. In CHF, the [sNa+]/[uNa+] ratio best correlates with PRA and reflects the basal activity as well as the rapid changes (as those induced by UF) of the RAS. Therefore, it can be considered a strong and easily available marker of PRA.

Key Words: Sodium concentration • Plasma renin activity • Heart failure • Ultrafiltration

Received April 19, 2001; Revised January 24, 2002; Accepted February 4, 2002


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