Renal Sodium Handling in Cirrhosis: A Reappraisal

Epstein, Murray

doi:10.1159/000181637

Cited by 22 publications

(4 citation statements)

References 14 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanisms mediating sodium retention in cirrhosis have been detailed in several recent reviews [6][7][8]. In brief, it is apparent that the perception of the determinants of deranged sodium homeostasis' is undergoing a reappraisal.…”

Section: Renal Sodium Handlingmentioning

confidence: 99%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

Self Cite

View full text Add to dashboard Cite

Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive. Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.

show abstract

Section: Renal Sodium Handlingmentioning

confidence: 99%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…A discussion of 'afferent' events usually includes consider ation of the detector element responsible for the recogni tion of the degree of volume alterations as well as a con sideration of the extracellular fluid (ECF) translocations or sequestration into serous spaces or interstitial fluid compartments that characterize advanced liver disease. Since I have recently reviewed in-depth the afferent per turbations that supervene in advanced liver disease [11][12][13], I will only briefly review the concepts of a dimin ished effective volume and the 'overflow' theory of as cites formation. The emphasis of this review will be on the efferent events mediating sodium retention.…”

Section: Pathogenesismentioning

confidence: 99%

Pathogenesis of Renal Sodium Handling in Cirrhosis

Epstein¹

1983

Am J Nephrol

Self Cite

View full text Add to dashboard Cite

“…A physiologic role for kinins in the regulation of renal sodium excretion, particularly in response to a sodium challenge, has been suggested by a number of studies [15,16], The role of kinins in sodium retention states has received less attention. Although the sodium retention of severe liver disease and ascites may have diverse etiologies, neurohumoral systems have been implicated [17],…”

Section: Discussionmentioning

confidence: 99%

The Kallikrein-Kininogen-Kinin System in Patients with Liver Disease and Ascites

Solomon

Azar

Trebbin

et al. 1988

Nephron

View full text Add to dashboard Cite

The urinary excretion of kininogen, kallikrein (total and active), and kinins were measured in 7 men with severe liver disease and ascites. The results were compared with a group of normal controls matched for sodium excretion. Significant reductions in kinin excretion were noted in the patients with liver disease which could not be accounted for by differences in age, plasma renin, aldosterone excretion or sodium excretion. Both active kallikrein and kininogen excretion were reduced suggesting that deficiencies of enzyme and substrate contributed to the kinin deficiency. The importance of kininogen in the physiologic regulation of kinin excretion in this clinical state is discussed.

show abstract

Renal Sodium Handling in Cirrhosis: A Reappraisal

Cited by 22 publications

References 14 publications

Management of Renal Complications of Liver Disease

Management of Renal Complications of Liver Disease

Pathogenesis of Renal Sodium Handling in Cirrhosis

The Kallikrein-Kininogen-Kinin System in Patients with Liver Disease and Ascites

Contact Info

Product

Resources

About