Abstract
Clinical states with portal venous hypertension are frequently associated with impairment in renal hemodynamics and water excretion, as well as increased renin secretion. In the present investigation, portal venous pressure (PVP) was increased in anesthetized dogs undergoing a water diuresis. Renal arterial pressure was maintained constant in all studies. As PVP was increased from 6 to 20 mm Hg, decreases in cardiac output (2.5-2.0 liter/min, P less than 0.05) and mean arterial pressure (140-131 mm Hg, P less than 0.05) were observed. Increases in PVP were also associated with decreases in glomerular filtration rate (GFR, 40-31 ml/min, P less than 0.001), renal blood flow (RBF, 276-193 ml/min, P less than 0.001), and increases in renin secretion (232-939 U/min, P less than 0.025) in innervated kidneys. No significant change in either GFR or RBF and a decrease in renin secretion occurred with increases in PVP in denervated kidneys. To dissociate the changes in cardiac output and mean arterial pressure induced by increase PVP from the observed decreases in GFR and RBF, studies were performed on animals undergoing constriction of the thoracic inferior vena cava. In these studies, similar decreases in cardiac output and mean arterial pressure were not associated with significant changes in GFR or RBF. Increases in PVP also were associated with an antidiuresis as urine osmolality increased from 101 to 446 mosmol/kg H2O (P less than 0.001). This antidiuresis was significantly blunted but not abolished by acute hypophysectomy. In hypophysectomized animals, changes in free water clearance and urine flow were linearly correlated as PVP was increased. These studies indicate that increases in PVP result in decreases in GFR and RBF and increases in renin secretion mediated by increased renal adrenergic tone. Increased PVP is also associated with antidiuresis; this antidiuresis is mediated both by vasopressin release and by diminished tubular fluid delivery to the distal nephron.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson R. J., Cadnapaphornchai P., Harbottle J. A., McDonald K. M., Schrier R. W. Mechanism of effect of thoracic inferior vena cava constriction on renal water excretion. J Clin Invest. 1974 Dec;54(6):1473–1479. doi: 10.1172/JCI107895. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Anderson R. J., Taher M. S., Cronin R. E., McDonald K. M., Schrier R. W. Effect of beta-adrenergic blockade and inhibitors of angiotensin II and prostaglandins on renal autoregulation. Am J Physiol. 1975 Sep;229(3):731–736. doi: 10.1152/ajplegacy.1975.229.3.731. [DOI] [PubMed] [Google Scholar]
- 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]
- Conn H. O. A rational approach to the hepatorenal syndrome. Gastroenterology. 1973 Aug;65(2):321–340. [PubMed] [Google Scholar]
- Epstein M., Berk D. P., Hollenberg N. K., Adams D. F., Chalmers T. C., Abrams H. L., Merrill J. P. Renal failure in the patient with cirrhosis. The role of active vasoconstriction. Am J Med. 1970 Aug;49(2):175–185. doi: 10.1016/s0002-9343(70)80073-0. [DOI] [PubMed] [Google Scholar]
- Haberich F. J., Aziz O., Nowacki P. E. Das Verhalten von Blutdruck und Diurese bei kurzfristigen Abklemmungen der Vena portae. Pflugers Arch Gesamte Physiol Menschen Tiere. 1966;288(2):151–161. [PubMed] [Google Scholar]
- JONES W. A., RAO D. R., BRAUNSTIN H. The renal glomerulus in cirrhosis of the liver. Am J Pathol. 1961 Oct;39:393–404. [PMC free article] [PubMed] [Google Scholar]
- Levy M. Renal function during acute graded elevation of portal venous pressure. Am J Physiol. 1974 Nov;227(5):1084–1087. doi: 10.1152/ajplegacy.1974.227.5.1084. [DOI] [PubMed] [Google Scholar]
- Liang C. C. The influence of hepatic portal circulation on urine flow. J Physiol. 1971 May;214(3):571–581. doi: 10.1113/jphysiol.1971.sp009449. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDonald K. M. Effect of hematocrit and colloid-induced changes in blood viscosity on renal hemodynamics and renin release in the dog. Circ Res. 1974 Jan;34(1):112–122. doi: 10.1161/01.res.40.4.112. [DOI] [PubMed] [Google Scholar]
- McKenna O. C., Angelakos E. T. Adrenergic innervation of the canine kidney. Circ Res. 1968 Mar;22(3):345–354. doi: 10.1161/01.res.22.3.345. [DOI] [PubMed] [Google Scholar]
- ONNIS M., SHUMACKER H. B., Jr, BOUNOUS G. Response to occlusion of the portal vein. Blood pressure and renal blood flow. Arch Surg. 1962 Dec;85:897–900. doi: 10.1001/archsurg.1962.01310060033008. [DOI] [PubMed] [Google Scholar]
- ORLOFF J., WAGNER H. N., Jr, DAVIDSON D. G. The effect of variations in solute excretion and vasopressin dosage on the excretion of water in the dog. J Clin Invest. 1958 Mar;37(3):458–464. doi: 10.1172/JCI103625. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ohm W., Haberich F. J. Uber den Einfluss des Druckes im Portalkreislauf auf die Diurese der wachen Ratte. Pflugers Arch. 1969;306(3):227–231. doi: 10.1007/BF00592434. [DOI] [PubMed] [Google Scholar]
- SCHEDL H. P., BARTTER F. C. An explanation for and experimental correction of the abnormal water diuresis in cirrhosis. J Clin Invest. 1960 Feb;39:248–261. doi: 10.1172/JCI104035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schrier R. W., Humphreys M. H. Factors involved in antinatriuretic effects of acute constriction of the thoracic and abdominal inferior vena cava. Circ Res. 1971 Nov;29(5):479–489. doi: 10.1161/01.res.29.5.479. [DOI] [PubMed] [Google Scholar]
- Schrier R. W., Lieberman R., Ufferman R. C. Mechanism of antidiuretic effect of beta adrenergic stimulation. J Clin Invest. 1972 Jan;51(1):97–111. doi: 10.1172/JCI106803. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schroeder E. T., Eich R. H., Smulyan H., Gould A. B., Gabuzda G. J. Plasma renin level in hepatic cirrhosis. Relaton to functional renal failure. Am J Med. 1970 Aug;49(2):186–191. doi: 10.1016/s0002-9343(70)80074-2. [DOI] [PubMed] [Google Scholar]
- Schroeder E. T., Numann P. J., Chamberlain B. E. Functional renal failure in cirrhosis. Recovery after portacaval shunt. Ann Intern Med. 1970 Jun;72(6):923–928. doi: 10.7326/0003-4819-72-6-923. [DOI] [PubMed] [Google Scholar]
- Stockigt J. R., Collins R. D., Biglieri E. G. Determination of plasma renin concentration by angiotensin I immunoassay. Diagnotic import of precise measurement of subnormal renin in hyperaldosteronism. Circ Res. 1971 May;28(5 Suppl):175–191. doi: 10.1161/01.res.28.5.ii-175. [DOI] [PubMed] [Google Scholar]
- TANCHE M., LEMARCHANDS H. Un mécanisme possible de l'arrêt de la diurèse consécutif à l'interruption de la circulation porte. J Physiol (Paris) 1958 Mar;50(2):538–540. [PubMed] [Google Scholar]
- THURAU K., DEETJEN P. [Diuresis in arterial pressure increases. Importance of hemodynamics of the renal medulla for urine concentration. With a theoretical contribution concerning H. Guenzler: "Counterflow systems with administration of substance through the external wall"]. Pflugers Arch Gesamte Physiol Menschen Tiere. 1962;274:567–580. [PubMed] [Google Scholar]
- TURNER M. D., SHERLOCK S., STEINER R. E. Splenic venography and intrasplenic pressure measurement in the clinical investigation of the protal venous system. Am J Med. 1957 Dec;23(6):846–859. doi: 10.1016/0002-9343(57)90294-2. [DOI] [PubMed] [Google Scholar]
- Taher M. S., McLain L. G., McDonald K. M., Schrier R. W., Gilbert L. K., Aisenbrey G. A., McCool A. L. Effect of beta adrenergic blockade on renin response to renal nerve stimulation. J Clin Invest. 1976 Feb;57(2):459–465. doi: 10.1172/JCI108297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tristani F. E., Cohn J. N. Systemic and renal hemodynamics in oliguric hepatic failure: effect of volume expansion. J Clin Invest. 1967 Dec;46(12):1894–1906. doi: 10.1172/JCI105679. [DOI] [PMC free article] [PubMed] [Google Scholar]