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. 1999 Nov;45(5):750–755. doi: 10.1136/gut.45.5.750

Renal distal tubular handling of sodium in central fluid volume homoeostasis in preascitic cirrhosis

G Sansoe 1, A Ferrari 1, E Baraldi 1, C Castellana 1, M C De Santis 1, F Manenti 1
PMCID: PMC1727721  PMID: 10517915

Abstract

BACKGROUND/AIMS—Patients with preascitic liver cirrhosis have an increased central plasma volume, and, for any given plasma aldosterone concentration, they excrete less sodium than healthy controls. A detailed study of the distribution of sodium reabsorption along the segments of the renal tubule, especially the distal one, is still lacking in preascitic cirrhosis.
METHODS—Twelve patients with Child-Pugh class A cirrhosis and nine control subjects (both groups on a normosodic diet) were submitted to the following investigations: (a) plasma levels of active renin and aldosterone; (b) four hour renal clearance of lithium (an index of fluid delivery to the loop of Henle), creatinine, sodium, and potassium; (c) dopaminergic activity, as measured by incremental aldosterone response to intravenous metoclopramide.
RESULTS—Metoclopramide induced higher incremental aldosterone responses, indicating increased dopaminergic activity in patients than controls, which is evidence of an increased central plasma volume (+30 min: 160.2 (68.8) v 83.6 (35.2) pg/ml, p<0.01; +60 min: 140.5 (80.3) v 36.8 (36.1) pg/ml, p<0.01). Patients had increased distal fractional sodium reabsorption compared with controls (26.9 (6.7)% v 12.5 (3.4)% of the filtered sodium load, p<0.05). In the patient group there was an inverse correlation between: (a) absolute distal sodium reabsorption and active renin (r −0.59, p<0.05); (b) fractional distal sodium reabsorption and sodium excretion (r −0.66, p<0.03).
CONCLUSIONS—These data suggest that in preascitic cirrhosis the distal fractional tubular reabsorption of sodium is increased and critical in regulating both central fluid volume and sodium excretion.


Keywords: kidney; sodium handling; lithium clearance; liver cirrhosis; dopamine; central fluid volume

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Figure 1  .

Figure 1  

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Inverse correlation between morning plasma levels of active renin and dopaminergic activity, evaluated from the incremental aldosterone plasma values 30 minutes after intravenous metoclopramide (IAPV), in Child-Pugh A cirrhotic patients.

Figure 2  .

Figure 2  

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Inverse correlation between morning plasma levels of active renin and renal lithium clearance (C-Li), an index of fluid delivery to the loop of Henle, in Child-Pugh A cirrhotic patients.

Figure 3  .

Figure 3  

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Inverse correlation between absolute distal tubular reabsorption of sodium (DRNa) and morning plasma levels of active renin in Child-Pugh A cirrhotic patients.

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