title: Increased plasma nitric oxide, L-arginine, and arginase-1 in cirrhotic patients with progressive renal dysfunction.
abstract: OBJECTIVE
  Increased levels of nitric oxide (NO) are hypothesized to contribute to renal dysfunction in patients with decompensated cirrhosis. In this study, we examined whether splanchnic and/or peripheral NO levels and L-arginine (L-Arg) correlate with progressive renal dysfunction in cirrhotics.
  
  
  METHODS
  Serum NO metabolites (NOx) and L-Arg were measured in: controls (n = 10); organ donors (n = 12); compensated cirrhotics (n = 17), cirrhotics with ascites (n = 25), refractory ascites (n = 11) or hepatorenal syndrome type II (HRS) (n = 11) and chronic renal failure patients (n = 18).
  
  
  RESULTS
  Plasma NOx and L-Arg levels rose progressively with worsening renal function in decompensated cirrhotics. Both NOx and L-Arg levels were highest in patients with HRS (P < 0.001 and P < 0.025, respectively). While there were no differences in NOx levels related to the site of sampling, L-Arg levels were lowest in hepatic venous blood. There were significant relationships of NOx and L-Arg with Model for End-Stage Liver Disease score and Child-Pugh scores (P < 0.04 and P < 0.01, respectively). Multivariate analysis showed a significant relationship between NOx, L-Arg and HRS.
  
  
  CONCLUSIONS
  Worsening renal function in decompensated cirrhosis is accompanied by progressive elevation in plasma NOx and L-Arg. These findings support the hypothesis that NO-mediated vasodilation is probably linked with the mechanism of progressive renal failure in decompensated cirrhotics.
authors.affiliation: Transplantation Institute, Loma Linda University Medical Center and Loma Linda University School of Medicine, Loma Linda, California 92354, USA. zkayali@llu.edu
authors.forename: Zeid
authors.initials: Z
authors.lastname: Kayali
authors.forename: Jason
authors.initials: J
authors.lastname: Herring
authors.forename: Pedro
authors.initials: P
authors.lastname: Baron
authors.forename: Edson
authors.initials: E
authors.lastname: Franco
authors.forename: Okechukwu
authors.initials: O
authors.lastname: Ojogho
authors.forename: Jason
authors.initials: J
authors.lastname: Smith
authors.forename: Gregory
authors.initials: G
authors.lastname: Watkins
authors.forename: Douglas
authors.initials: D
authors.lastname: Smith
authors.forename: Victor
authors.initials: V
authors.lastname: Lamin
authors.forename: Thanh
authors.initials: T
authors.lastname: Hoang
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.forename: Meleah
authors.initials: M
authors.lastname: Mathahs
authors.forename: Lawrance
authors.initials: L
authors.lastname: Sowers
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Brown
authors.forename: Warren N
authors.initials: WN
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D001119:Arginase / Q000097:blood*; D001120:Arginine / Q000097:blood*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006530:Hepatorenal Syndrome / Q000097:blood*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood*; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D009569:Nitric Oxide; D001120:Arginine; D001119:Arginase