One-week losartan administration increases sodium excretion in cirrhotic patients with and without ascites.
BACKGROUND
Losartan, a highly selective angiotensin II type 1 receptor antagonist, has been reported to have a significant portal hypotensive effect in cirrhotic patients. A recent study also showed that losartan exerted a dramatic natriuretic effect in preascitic cirrhosis. The influence of losartan on renal hemodynamics and sodium homeostasis in cirrhotic patients with ascites is unclear. This study was undertaken to evaluate the renal effects of 1-week losartan treatment in cirrhotic patients with and without ascites.


METHODS
All 12 patients in the study received a daily oral dose of 25 mg losartan for 7 consecutive days. Effective renal plasma flow, urine volume, creatinine clearance, 24h urine sodium excretion and fractional excretion of sodium, blood urea nitrogen, and serum creatinine were measured before and after treatment.


RESULTS
In cirrhotic patients without ascites, creatinine clearance, 24-h urinary sodium excretion, and fractional excretion of sodium were significantly increased after losartan administration. Effective renal plasma flow and serum creatinine showed almost no change after treatment. In cirrhotic patients with ascites, creatinine clearance, 24-h urinary sodium excretion, fractional excretion of sodium, and effective renal plasma flow were significantly increased after losartan administration. In addition, the magnitudes of the increases in the fractional excretion of sodium and in the 24-h urinary sodium excretion were greater in cirrhotic patients with ascites than in those without ascites.


CONCLUSIONS
One-week treatment with losartan increases sodium excretion in association with an improvement of renal function in cirrhotic patients with and without ascites. The natriuretic effect was more profound in cirrhotic patients with ascites than in those without ascites.
Yang
Ying-Ying
YY
Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan.
Lin
Han-Chieh
HC
Lee
Wui-Chiang
WC
Hou
Ming-Chih
MC
Lee
Fa-Yauh
FY
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001201:Ascites / Q000188:drug therapy*; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005355:Fibrosis / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017596:Renal Plasma Flow, Effective / Q000187:drug effects; D012964:Sodium / Q000652:urine*
D000959:Antihypertensive Agents; D012964:Sodium; D003404:Creatinine; D019808:Losartan