Sodium handling in patients with well compensated cirrhosis is dependent on the severity of liver disease and portal pressure.
OBJECTIVE
To test the contribution of portal pressure gradient (PPG) and neurohumoral factors to sodium handling in cirrhotic patients without ascites, by comparing preascitic cirrhotic patients with patients with transjugular intrahepatic portosystemic stent shunt (TIPSS) and previous ascites.


METHODS
Ten patients with TIPSS and 10 preascitic cirrhotic patients.


METHODS
Changes in glomerular filtration, renal plasma flow, urinary sodium excretion (U(Na)V), and neurohumoral factors were measured before and for two hours after infusion of one litre of 0. 9% saline over one hour.


RESULTS
Glomerular filtration rate and renal plasma flow were significantly higher in patients with TIPSS compared with preascitic cirrhotic patients. Following saline infusion both parameters increased significantly; this increase was significantly greater in patients with TIPSS. U(Na)V increased significantly in both groups following saline infusion. The increase in U(Na)V was significantly greater in the TIPSS group. Plasma renin activity and angiotensin II decreased significantly in both groups. Basal U(Na)V was independently correlated with angiotensin II concentration and PPG and the change in U(Na)V correlated with the PPG.


CONCLUSIONS
Results suggest that patients with advanced liver disease and low portal pressure handle sodium as well as patients with compensated liver disease and high portal pressure. These results are consistent with the notion that in addition to peripheral vasodilatation and severity of liver disease, the severity of portal hypertension contributes to the abnormalities of sodium retention in cirrhosis.
Jalan
R
R
Liver Unit, Department of Medicine and Centre for Liver and Digestive Diseases, Lauriston Place, Edinburgh, UK.
Hayes
P C
PC
D000704:Analysis of Variance; D000804:Angiotensin II / Q000032:analysis; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D017595:Renal Plasma Flow / Q000187:drug effects; D012964:Sodium / Q000378:metabolism* / Q000494:pharmacology
D000804:Angiotensin II; D012964:Sodium