Naslov
Impairment of renal sodium and water excretion in the cirrhosis of the liver

Autori
Degoricija, Vesna ; Šefer, Siniša ; Zjačić-Rotkvić, Vanja ; Troskot, Branko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Intensive Care Medicine / Falke, Konrad ; Gerlach, Herwig - Rim : Springer, 2000, S 281-S 281

Skup
13th Annual Congress of European Society of Intensive Care Medicine

Mjesto i datum
Rim, Italija, 01.10.2000. - 04.10.2000

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
liver cirrhosis; therapy; ascites; paracentesis; renal function

Sažetak
Introduction. The pathogenesis of renal sodium and water retention in cirrhosis involves a relative underfilling of the arterial vascular compartment with activation of RAA axis, sympathetic system and non osmotic release of ADH, failure of escape from the sodium retaining effect of aldosteron and renal resistance to ANP. The aim of the study was to assess renal sodium and water excretion in patients with refractory tense ascites. Methods. 5o patients with Child-Pugh C cirrhosis and tense ascites were randomly allocated into 5 grups. Mean arterial pressure, pulse rate, urine flow rate, hepatic encephalopathy, serum creatinin, creatinin clearance, osmolality clearance, free water clearance and urin sodium et potassium excretion rates were measured before, 6 h and on the 2nd, 3rd, and 6th day after treatment. 30 patients were treated with paracentesis (6 L) associated with plasma volume expansion (200 mL 20% human albumin, 600 mL fresh frosen plasma, 900 mL solution of synthetic gelatin) and bed rest 24 h before and after the procedure, versus 10 patients treated with paracentesis of 6 L of ascites without volume replacement and bed rest and 10 patients treated with furosemid 40 mg intravenously every day and no bed rest. Results. Paracentesis without bed rest 24 h before and after the procedure and plasma volume expansion is associated with a significant hypotension, tachycardia, insufficient weight loss, worsening of hepatic encephalopathy, renal impairment, and greater risk of hepatorenal syndrome. Paracentesis with bed rest and volume replacement is more effective than diuretic therapy in the treatment of patients with cirrhosis with tense ascites and is associated with a lower incidence of complications. The difference is mainly due to a higher incidence of hepatic encephalopathy in the former group.The hepatic encephalopathy during diuretic therapy is due to volume depletion, occurs in patients with possitive response to diuretics, particulary if peripheral edema are not present, and is rapidly reversible after discontinuation of therapy. However comparisons between groups did not provide significant differences at any time in negative free water clearance Conclusion. None of the protocols did have aquaretic efficacy. The inability to excrete solute-free water is one of the strongest predictors for developing hepatorenal syndrome. The pathogenesis is primarily related to the non-osmotic hypersecretion of vasopressin, whereas additional factors such as renal prostaglandins and distal sodium delivery are contributing factors. Patients with cirrhosis should be observed at least for 6 days after the large volume paracentesis for evidence of progressively deteriorating renal function, worsening electrolyte imbalance or hepatic encephalopathy. References. 1. Schrier RW, Arroyo V, Bernardi M. Peripheral arterial vasodilatation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988 ; 8:1151-7. 2. Jespersen B. Regulation of renal sodium and water excretion in the nephrotic syndrome and cirrhosis of the liver. Dan Med Bull 1997 ; 44:191-207.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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