Renal sodium handling in cirrhosis with ascites: mechanisms of impaired natriuretic response to reclining
| Autor: | Antonio Gasbarrini, Amedeo Ligabue, Lorenzo Fornalè, Claudio Di Marco, Mario Baraldini, Giovanni Gasbarrini, Mauro Bernardi, Franco Trevisani |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Natriuresis Renal function Kidney Norepinephrine (medication) Norepinephrine chemistry.chemical_compound Internal medicine Ascites Prone Position Supine Position Humans Medicine Aldosterone Aged Hepatology business.industry Sodium Middle Aged medicine.disease Pathophysiology Endocrinology chemistry Renal sodium excretion medicine.symptom business Atrial Natriuretic Factor medicine.drug |
| Zdroj: | Journal of Hepatology. 21:1116-1122 |
| ISSN: | 0168-8278 |
| DOI: | 10.1016/s0168-8278(05)80628-2 |
| Popis: | We recently showed that patients with compensated cirrhosis can dispose of their fluid overload while reclining. In contrast, patients with ascites fail to develop supine-induced natriuresis. To assess the effect of reclining on renal sodium handling in patients with advanced cirrhosis and the mechanisms blunting natriuresis in this situation, renal function and plasma concentrations of atrial natriuretic factor, aldosterone and norepinephrine were evaluated in 10 nonazotemic patients with cirrhosis and ascites and 10 healthy controls standing for 2 h and reclining for 2 h. While standing, all patients showed marked sodium retention and significantly elevated plasma atrial natriuretic factor levels, aldosterone and norepinephrine. Glomerular filtration rate did not differ from healthy controls. The reclining increased renal sodium excretion in both groups, but this change was far less marked in patients; natriuresis only rose to the control range in two of them. An increase in atrial natriuretic factor and a depression of plasma aldosterone and norepinephrine was seen in both controls and patients. In the latter, despite the greater change in atrial natriuretic factor and aldosterone, the aldosterone to atrial natriuretic factor ratio, which was inversely correlated with natriuresis during both standing and reclining remained significantly elevated. In the two patients who achieved normal natriuresis during reclining, reclining was associated with both the normalization of the aldosterone/atrial natriuretic factor ratio, and with an increase in glomerular filtration rate. The supine-induced increase in atrial natriuretic factor was not only preserved but was even enhanced in cirrhosis with ascites. In most cases, however, this was not associated with a large enough shift in the plasma aldosterone/atrial natriuretic factor balance to prime clinically significant natriuresis. To achieve this result, suppression of aldosterone secretion, supernormal release of atrial natriuretic factor and improvement of renal perfusion pressure have to concur. |
| Databáze: | OpenAIRE |
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