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. 1967 Dec;46(12):1894–1906. doi: 10.1172/JCI105679

Systemic and Renal Hemodynamics in Oliguric Hepatic Failure: Effect of Volume Expansion*

Felix E Tristani 1, Jay N Cohn 1
PMCID: PMC292942  PMID: 6073996

Abstract

Systemic and renal hemodynamics were studied by indicator dilution techniques before and after infusion of 500 ml of dextran 40 in 21 patients with renal failure developing in the course of decompensated cirrhosis.

Cardiac index was directly correlated with total blood volumes. Renal blood flow was low and renal vascular resistance elevated in 13 of 15 patients. Renal vascular resistance was directly related to total systemic nonrenal vascular resistance. Two patients with the highest cardiac outputs in the group were oliguric with high renal blood flow.

Plasma volume expansion increased cardiac output in 19 of 21 patients and increased renal blood flow in 12 of 14. The patients were divided into two groups on the basis of control cardiac index. Those with lower cardiac index had lower blood volumes and responded to dextran with a 73% increase in cardiac output, a 148% increase in renal blood flow, and a rise in renal fraction. Those with high control cardiac index had significantly higher blood volumes and responded to dextran with only a small average rise in cardiac output and renal blood flow.

Systolic arterial pressure was less than 100 mm Hg in 12 patients. When compared to the normotensive subjects, this hypotension was characterized by a lower vascular resistance, a tendency for a lesser rise in renal blood flow after volume expansion, and a more rapid demise.

The prompt circulatory improvement after volume expansion in many of these patients indicates that functional plasma volume depletion may be an important factor in the renal vasoconstriction of oliguric hepatic failure. In an attempt to sustain volume expansion, reinfusion of ascitic fluid was accomplished in four patients. Normal renal blood flow was maintained during reinfusion and a diuresis always occurred, but the response usually was not maintained after the infusion was terminated.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BALDUS W. P., SUMMERSKILL W. H., HUNT J. C., MAHER F. T. RENAL CIRCULATION IN CIRRHOSIS: OBSERVATIONS BASED ON CATHETERIZATION OF THE RENAL VEIN. J Clin Invest. 1964 Jun;43:1090–1097. doi: 10.1172/JCI104993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BALINT P., FEKETE A., FORGACS I. QUANTITATIVE CONSIDERATIONS ON THE STORAGE OF CLEARANCE SUBSTANCES IN THE KIDNEY. Clin Sci. 1964 Apr;26:345–350. [PubMed] [Google Scholar]
  3. Cohn J. N., Gombos E. A. Unilateral renal hemodynamics studied by an indicator-dilution technic in man. Am J Cardiol. 1965 Dec;16(6):820–827. doi: 10.1016/0002-9149(65)90699-5. [DOI] [PubMed] [Google Scholar]
  4. Cohn J. N., Luria M. H. Studies in clinical shock and hypotension. IV. Variations in reflex vasoconstriction and cardiac stimulation. Circulation. 1966 Nov;34(5):823–832. doi: 10.1161/01.cir.34.5.823. [DOI] [PubMed] [Google Scholar]
  5. GELIN L. E., INGELMAN B. Rheomacrodex--a new dextran solution for rheological treatment of impaired capillary flow. Acta Chir Scand. 1961 Nov;122:294–302. [PubMed] [Google Scholar]
  6. GREGERSEN M. I., RAWSON R. A. Blood volume. Physiol Rev. 1959 Apr;39(2):307–342. doi: 10.1152/physrev.1959.39.2.307. [DOI] [PubMed] [Google Scholar]
  7. KOWALSKI H. J., ABELMANN W. H. The cardiac output at rest in Laennec's cirrhosis. J Clin Invest. 1953 Oct;32(10):1025–1033. doi: 10.1172/JCI102813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. LANCESTREMERE R. G., DAVIDSON P. L., EARLEY L. E., O'BRIEN F. J., PAPPER S. Renal failure in Laennec's cirrhosis. II. Simultaneous determination of cardiac output and renal hemodynamics. J Clin Invest. 1962 Oct;41:1922–1927. doi: 10.1172/JCI104649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. LANCESTREMERE R. G., KLINGLER E. L., Jr, FRISCH E., PAPPER S. Simultaneous determination of cardiac output and renal function in patients with Laennec's cirrhosis during the administration of the pressor amine, metaraminol. J Lab Clin Med. 1963 May;61:820–825. [PubMed] [Google Scholar]
  10. LILIENFIELD L. S., ROSE J. C., LASSEN N. A. Diverse distribution of red cells and albumin in the dog kidney. Circ Res. 1958 Nov;6(6):810–815. doi: 10.1161/01.res.6.6.810. [DOI] [PubMed] [Google Scholar]
  11. ONEN K. H. Renal haemodynamics in hepatic cirrhosis. Lancet. 1960 Jan 23;1(7117):203–204. doi: 10.1016/s0140-6736(60)90116-1. [DOI] [PubMed] [Google Scholar]
  12. ONNIS M., SHUMACKER H. B., Jr, BOUNOUS G. Blood pressure and renal blood flow response to occlusion of visceral arteries. Ann Surg. 1963 Jan;157:56–61. doi: 10.1097/00000658-196301000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. OWEN C. A., Jr, POWER M. H. Intercellular plasma of centrifuged human erythrocytes as measured by means of iodo 131 albumin. J Appl Physiol. 1953 Jan;5(7):323–329. doi: 10.1152/jappl.1953.5.7.323. [DOI] [PubMed] [Google Scholar]
  14. PAPPER S., BELSKY J. L., BLEIFER K. H. Renal failure in Laennec's cirrhosis of the liver. I. Description of clinical and laboratory features. Ann Intern Med. 1959 Oct;51:759–773. doi: 10.7326/0003-4819-51-4-759. [DOI] [PubMed] [Google Scholar]
  15. PAPPER S. The role of the kidney in Laennec's cirrhosis of the liver. Medicine (Baltimore) 1958 Dec;37(4):299–316. doi: 10.1097/00005792-195812000-00002. [DOI] [PubMed] [Google Scholar]
  16. SHEAR L., HALL P. W., 3rd, GABUZDA G. J. RENAL FAILURE IN PATIENTS WITH CIRRHOSIS OF THE LIVER. II. FACTORS INFLUENCING MAXIMAL URINARY FLOW RATE. Am J Med. 1965 Aug;39:199–209. doi: 10.1016/0002-9343(65)90042-2. [DOI] [PubMed] [Google Scholar]
  17. SHEAR L., KLEINERMAN J., GABUZDA G. J. RENAL FAILURE IN PATIENTS WITH CIRRHOSIS OF THE LIVER. I. CLINICAL AND PATHOLOGIC CHARACTERISTICS. Am J Med. 1965 Aug;39:184–198. doi: 10.1016/0002-9343(65)90041-0. [DOI] [PubMed] [Google Scholar]
  18. Seaman G. V., Hissen W., Lino L., Swank R. L. Physico-chemical changes in blood arising from dextran infusions. Clin Sci. 1965 Oct;29(2):293–304. [PubMed] [Google Scholar]
  19. Summerskill W. H. Hepatic failure and the kidney. Gastroenterology. 1966 Jul;51(1):94–107. [PubMed] [Google Scholar]
  20. THURAU K. RENAL HEMODYNAMICS. Am J Med. 1964 May;36:698–719. doi: 10.1016/0002-9343(64)90181-0. [DOI] [PubMed] [Google Scholar]
  21. Teschan P. E., Lawson N. L. Studies in acute renal failure. Prevention by osmotic diuresis, and observations on the effect of plasma and extracellular volume expansion. Nephron. 1966;3(1):1–16. doi: 10.1159/000179422. [DOI] [PubMed] [Google Scholar]

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