Efficacy of low-dose captopril in addition to furosemide and spironolactone in patients with decompensated liver disease during blunted diuresis
| Autor: | A.A. van Vliet, W.H. Hackeng, AB J.M. Donker, S.G.M. Meuwissen |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Captopril medicine.medical_treatment Diuresis Spironolactone Kidney Plasma renin activity Natriuresis Furosemide Renal Dialysis Internal medicine Ascites Renin medicine Humans Aldosterone Cyclic GMP Aged Hepatology Dose-Response Relationship Drug business.industry Angiotensin II Weight change Sodium Middle Aged Endocrinology Liver Creatinine Drug Therapy Combination Female Diuretic medicine.symptom business Atrial Natriuretic Factor medicine.drug Follow-Up Studies |
| Zdroj: | Journal of hepatology. 15(1-2) |
| ISSN: | 0168-8278 |
| Popis: | The renin-angiotensin-aldosterone system is activated by diuretics and involved in the diuretic resistance of cirrhotic patients with ascites and oedema. In previous studies relatively high doses of captopril (25-400 mg daily) were unsuccessful in promoting diuresis and natriuresis in these patients. We analyzed the efficacy of a low dose of captopril in eight patients with massive ascites resistant to therapy of salt/fluid restriction and increasing doses of spironolactone and furosemide. Mean duration of diuretic use was 73 days (range 7-240 days). After at least 3 days of observation on 80 mg furosemide and 100 mg spironolactone only, captopril was added. Four out of eight patients responded with an increase in natriuresis and diuresis; daily dose of captopril was 20.6 mg in responders and 26.5 mg in non-responders. After the addition of captopril the mean weight change was -7.5 kg in responders and +0.25 kg in non-responders. Mean urinary sodium output in responders increased from 72.8 (S.D. = 35.2) to 128.5 (63.5) mmol within 10 days. Increased diuresis in responders made diuretic reduction necessary: mean furosemide from 80 to 53.3 mg, and mean spironolactone from 100 to 68.1 mg. Creatinine clearances remained stable. High levels of plasma renin activity, plasma aldosterone and angiotensin-II were found in all patients. Non-responders showed more severe hyponatremia and higher vasopressin levels. Natriuretic atrial factor (NAF) was in the upper-normal range or slightly elevated in both groups. In non-responders we noticed low levels of cGMP in 24-h urine, compared with responders.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Databáze: | OpenAIRE |
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