Diuretic-induced renal impairment without volume depletion in cirrhosis: changes in the renin-angiotensin system and the effect of beta-adrenergic blockade.
In 4 patients with cirrhosis and ascites, diuretic therapy resulted in an impairment of renal function that was associated with a rise in plasma renin activity (PRA). In 3, this occurred in the absence of volume depletion. When diuretics were discontinued, renal function returned to normal. beta-adrenergic blocking drugs were then given to suppress renin secretion and diuretics restarted. On this occasion, impairment of renal function did not occur. In 2 further patients, administration of beta-adrenergic blockers during a period of diuretic-induced renal impairment resulted in an improvement in renal function. Although these findings may indicate that diuretic-induced renal impairment in cirrhosis is at least partly due to activation of the renin-angiotensin system, in another group of patients a diuretic-induced rise in PRA was not associated with a deterioration in renal function.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005665:Furosemide / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D013148:Spironolactone / Q000009:adverse effects*; D014508:Urea / Q000097:blood
D000319:Adrenergic beta-Antagonists; D013148:Spironolactone; D005665:Furosemide; D014508:Urea; D003404:Creatinine; D012083:Renin