title: Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury.
abstract: OBJECTIVE
  In cirrhotic patients with renal failure, renal blood flow autoregulation curve is shifted to the right, which is consequent upon sympathetic nervous system activation and endothelial dysfunction. Albumin infusion improves renal function in cirrhosis by mechanisms that are incompletely understood. We aimed to determine the effect of albumin infusion on systemic haemodynamics, renal blood flow, renal function and endothelial function in patients with acute decompensation of cirrhosis and acute kidney injury.
  
  
  METHODS
  Twelve patients with refractory ascites and 10 patients with acute decompensation of cirrhosis and acute kidney injury were studied. Both groups were treated with intravenous albumin infusion, 40-60 g/days over 3-4 days. Cardiac and renal haemodynamics were measured. Endothelial activation/dysfunction was assessed using von Willebrand factor and serum nitrite levels. F2α Isoprostanes, resting neutrophil burst and noradrenaline levels were quantified as markers of oxidative stress, endotoxemia and sympathetic activation respectively.
  
  
  RESULTS
  Albumin infusion leads to a shift in the renal blood flow autoregulation curve towards normalization, which resulted in a significant increase in renal blood flow. Accordingly, improvement of renal function was observed. In parallel, a significant decrease in sympathetic activation, inflammation/oxidative stress and endothelial activation/dysfunction was documented. Improvement of renal blood flow correlated with improvement in endothelial activation (r = 0.741, P < 0.001).
  
  
  CONCLUSIONS
  The data suggest that albumin infusion improves renal function in acutely decompensated cirrhotic patients with acute kidney injury by impacting on renal blood flow autoregulation. This is possibly achieved through endothelial stabilization and a reduction in the sympathetic tone, endotoxemia and oxidative stress.
authors.affiliation: Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, Pond Street, London, NW3 2PF, UK.
authors.forename: Rita
authors.initials: R
authors.lastname: Garcia-Martinez
authors.forename: Lorette
authors.initials: L
authors.lastname: Noiret
authors.forename: Sambit
authors.initials: S
authors.lastname: Sen
authors.forename: Rajeshwar
authors.initials: R
authors.lastname: Mookerjee
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008875:Middle Aged; D012079:Renal Circulation / Q000187:drug effects*; D016897:Respiratory Burst / Q000187:drug effects; D012189:Retrospective Studies; D012709:Serum Albumin / Q000008:administration & dosage / Q000494:pharmacology*; D018709:Statistics, Nonparametric; D017392:Thiobarbituric Acid Reactive Substances; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D012709:Serum Albumin; D017392:Thiobarbituric Acid Reactive Substances; D014841:von Willebrand Factor; D008315:Malondialdehyde
keywords: acute kidney injury; albumin; cirrhosis; endothelial dysfunction; human; refractory ascites; renal blood flow