Renal Failure with Cirrhosis

Abstract

This investigation was undertaken to determine what role diuretics are playing in the production of renal failure in patients with cirrhosis and ascites. Plasma volume and renal hemodynamics were measured before and after large diureses in 43 patients. There were small decreases in mean creatinine clearance and plasma volume which were statistically significant. Five patients had substantial falls in creatinine clearance, and in all of them there was a drop in plasma volume. Creatinine clearance returned to pre-diuresis levels, either spontaneously or with an expansion of plasma volume associated with increased sodium intake. No patient went on to develop serious renal failure. During the 24 months required for this study, an additional 300 patients with cirrhosis and ascites were treated in the unit. Among these were 25 who developed severe renal failure. Nineteen of the 25 had not undergone a prior diuresis as judged by weight loss. We concluded, therefore, that drug-induced diuresis is not responsible for the majority of instances of severe renal failure accompanying cirrhosis. Whether it can be an occasional precipitating cause in susceptible patients is still open to question.