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a Gastroenterology
Unit, Gradenigo Hospital, Torino, Italy, b Department of Gastroenterology, Department of
Internal Medicine, University of Modena, Modena, Italy, c Department of
Endocrinology, Department of Internal Medicine, University of Modena,
Modena, Italy, d Department
of Clinical Pharmacology, Department of Internal Medicine, University
of Modena, Modena, Italy
Correspondence to: Dr G Sansoè, Divisione di Gastroenterologia, Ospedale Gradenigo, C.so Regina Margherita 8, 10153 Torino, Italy.
Accepted for publication 2 June 1999
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.
METHODSTwelve
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.
RESULTSMetoclopramide
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).
CONCLUSIONSThese 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.
Relevant Article
This article has been cited by other articles:
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  G Sansoe and F Wong Natriuretic and aquaretic effects of intravenously infused calcium in preascitic human cirrhosis: physiopathological and clinical implications Gut, August 1, 2007; 56(8): 1117 - 1123. [Abstract] [Full Text] [PDF]
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 M. Graebe, L. Brond, S. Christensen, S. Nielsen, N. V. Olsen, and T. E. N. Jonassen Chronic nitric oxide synthase inhibition exacerbates renal dysfunction in cirrhotic rats Am J Physiol Renal Physiol, February 1, 2004; 286(2): F288 - F297. [Abstract] [Full Text] [PDF]
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G Sansoe, A M Biava, S Silvano, A Ferrari, F Rosina, A Smedile, A Touscoz, L Bonardi, and M Rizzetto Renal tubular events following passage from the supine to the standing position in patients with compensated liver cirrhosis: loss of tubuloglomerular feedback Gut, November 1, 2002; 51(5): 736 - 741. [Abstract] [Full Text] [PDF]
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F Wong, P Liu, and L Blendis Sodium homeostasis with chronic sodium loading in preascitic cirrhosis Gut, December 1, 2001; 49(6): 847 - 851. [Abstract] [Full Text] [PDF]
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G SANSOE, A FERRARI, J CLARIA, and J RODES Renal sodium handling in preascitic cirrhosis Gut, May 1, 2001; 48(5): 740a - 741. [Full Text] [PDF]
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