Intrarenal adaptation in COPD. [Adattamenti intrarenali nella BPCO.]

Mechanisms leading to peripheral oedema in COPD in the absence of decreased cardiac output are not well known. Kidney response to hypoxemia and hypercapnia could be associated to the release of local paracrine substances. In COPD patients abnormalities of hormonal levels have been documentated in renal handling during acute exacerbation. We have shown alterations of the metabolism of endothelin, a potent endothelial and epithelial derived factor, in COPD patients, that were significantly associated to a subclinic impairment of scintigraphic indexes of glomerular function. These abnormalities might have implications for the pharmacological intervention in advanced chronic respiratory failure.