RENAL FUNCTION AS A FACTOR IN FLUID RETENTION IN PATIENTS WITH CIRRHOSIS OF THE LIVER 1

Abstract

32 renal functional measurements were done on 17 patients with cirrhosis of the liver at different stages of the disease. The measurements done were the filtration rate (inulin clearance), effective renal plasma flow (p-aminohippuric acid clearance) and maximal tubular excretion of p-aminohippuric acid. The patients were divided into 3 groups (as the patients improved and the clearances were repeated at such times, their data was included in the indicated group): Group I consisted of 6 patients in whom ascites had either never been present or in whom it was never sufficiently severe to require paracentesis. Eleven clearances were detd. in this group. Group II consisted of 6 patients who had all required paracentesis during the course of therapy but at the time of the clearance studies, as a result of therapy, ascites was not severe enough to require further taps. Ten clearances were done in this group. Group III consisted of 7 patients in whom ascitic fluid rapidly reaccumulating, so that taps were required at intervals of from 7 to 16 days. Eleven clearances were measured in this group. The clearances were done 1 or 2 days following the tap in order to avoid the factor of increased intra-abdominal pressure. To evaluate the effect of the intra-abdominal pressure resulting from the presence in the absomen of large amts. of ascitic fluid, clearances were done in several patients at times when the abdomen was grossly distended with fluid and at short intervals after a tap, when there was much less fluid in the abdomen. Clearance detns. were repeated more than once in 7 patients and in 2 subjects the clearances were repeated at intervals during the course of the disease, a period of 12-15 months, until ascites was controlled. In the patients in Group I none of the clearance measurements was depressed. In the patients in Group n, the filtration rates were below the mean normal value in 2 cases and the values otherwise were within normal limits. In the patients in Group III, in whom ascitic fluid accumulated rapidly and who required repeated taps, all of the clearance measurements were depressed. Once ascites was controlled, so that further paracenteses were not required, the renal functional measurements became normal. The amount of ascitic fluid present in the abdomen at the time the clearance studies were done did not significantly affect the already depressed clearance values. The studies demonstrate that there is a functional depression of the kidney in patients with cirrhosis of the liver during the phase of the disease when ascites is pronounced. Apparently, the disturbance in kidney function is reversible and if the patient improves with therapy, kidney function will return to normal. The reestablishment of a normally functioning kidney is associated with diuresis, which results in the control of ascites.