The Renal Circulation in Shock 1

The status of the circulation through the kidneys during peripheral circulatory failure, or shock, is of interest inasmuch as kidney function is entirely dependent upon the circulation, and because a knowledge of the alterations in circulatory dynamics in one highly vascular region, such as the kidney, may contribute to the under- standing of the mechanisms of regional redistri- bution of the circulation in the shock syndrome.Clinical material.These studies formed an integral part of an investigation of shock in man, carried out at Bellevue Hospital.Methods of study and organizational detail have been previously reported (1).As far as possible, the procedures were planned to yield a compre- hensive, well-integrated picture.Renal clearances were measured in 35 patients, 18 to 71 years of age, of whom 27 were males and 8 were females.'They may be classified etio- logically as follows: (a) skeletal trauma without shock, 3 cases; with shock, 11 cases; (b) hemor- rhage without shock, one case; with shock, 9 cases (including 3 patients with cirrhosis of the liver and ruptured esophageal varices, and 3 who were later found to have mild or moderate essential hypertension); (c) peritoneal inflamma- tion, 2 cases; one with necrosis of the lower colon and peritonitis resulting from a Lysol enema, but not in shock; and one in severe collapse from a strangulated hernia of 4 days' duration; (d) third degree burns, 2 cases; one in moderate shock and the other showing no evidence of I This investigation was carried on under a contract, recommended by the Committee on Medical Research, between the Office of Scientific Research and Development and Columbia University, with the collaboration of New York