RENAL FAILURE IN LAENNEC'S CIRRHOSIS OF THE LIVER. I. DESCRIPTION OF CLINICAL AND LABORATORY FEATURES

Abstract

The present report is concerned with 22 patients with Laennec''s cirrhosis who developed renal failure. In 9, this occurred after mild gastrointestinal bleeding; in 3 after paracentesis; in 5 while jaundice was severe or progressive and in 4 without apparent precipitating causes. Renal failure may develop within a period of days, weeks or months, thus suggesting that the mechanism of this syndrome cannot be attributed to chronic progressive renal disease. Hypotension, hyponatremia, ascites and jaundice were generally present, although progressive jaundice was not requisite. Early in the renal failure, decreased filtration rate was often associated with a well concentrated urine. Subseuqnetly the osmolar concentration of the scanty urine often decreased towards that of plasma. Aside from bile staining the kidneys were normal histologically. All patients died. While the mechanism of this syndrome remains unclear, present data are most consistent with the presence of reduced glomerular filtration rate and renal plasma flow rather than any true renal parenchymal disease. The cause of the diminished blood flow to the kidney is unknown. It is not established that renal failure was the cause of death; the renal failure probably was merely a part of a broad terminal event.