Renal effects of NO‐inhibition in patients with cirrhosis vs. healthy controls: a randomized placebo‐controlled crossover study. (28th June 2013)

• Record Type: Journal Article
• Authors: Bech, Jesper N.; Aagaard, Niels K.; Pedersen, Robert S.; Sorensen, Tina B.; Vilstrup, Hendrik; Pedersen, Erling B.
• Is Part Of: Liver international. Volume 34:Number 2(2014:Mar.)
• Page Start: 211
• Page End: 219
• Publication Date: 2013-06-28
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12233
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12233-abs-0001"> <title>Abstract</title> <sec id="liv12233-sec-0001" sec-type="section"> <title>Background</title> <p>Nitric oxide (NO) is an important regulator of renal hemodynamics and sodium excretion. Systemic and splanchnic NO‐synthesis is increased in liver cirrhosis contributing to the characteristic hyperdynamic circulation. The significance of renal NO in human cirrhosis is not clear.</p> </sec> <sec id="liv12233-sec-0002" sec-type="section"> <title>Aims</title> <p>In order to clarify the role of NO in the regulation of renal hemodynamics and sodium excretion in human cirrhosis, we studied the effects of N<sup><italic>G</italic></sup>‐monomethyl‐L‐arginine (<sc>l</sc>‐NMMA) – a nonselective NO‐inhibitor – on blood pressure (MAP), heart rate (HR), GFR, RPF, U<sub>Na</sub> × V, FE<sub>Na</sub>, FE<sub>Li</sub> and plasma levels of renin, angII, aldo, ANP, BNP and cGMP in 13 patients with cirrhosis (Child gr.A: 8; Child gr.B+C: 5) and 13 healthy controls.</p> </sec> <sec id="liv12233-sec-0003" sec-type="section"> <title>Methods</title> <p>The study was randomized and placebo‐controlled. Renal hemodynamics were assessed by measuring renal clearance of <sup>51</sup>Cr‐EDTA and <sup>125</sup>I‐Hippuran for GFR and RPF, respectively.</p> </sec> <sec id="liv12233-sec-0004" sec-type="section"> <title>Results</title> <p> <sc>l</sc>‐NMMA induced a similar, significant increase in MAP in both groups and a more pronounced relative decrease in HR in the CIR group (<italic>P</italic> = 0.0209, <sc>anova</sc>). <sc>l</sc>‐NMMA did not change GFR in any group, but RPF decreased significantly in both groups, but most pronouncedly in CIR (<italic>P</italic> = 0.0478, <sc>anova</sc>). FENa decreased significantly in both groups after <sc>l</sc>‐NMMA, but the response was again most pronounced in the CIR group (<italic>P</italic> = 0.0270, <sc>anova</sc>). All parameters remained stable after placebo. No significant differences were observed between the effects of <sc>l</sc>‐NMMA in Child gr.A vs. Child gr. B+C patients.</p> </sec> <sec id="liv12233-sec-0005" sec-type="section"> <title>Conclusion</title> <p>The data supports the hypothesis that renal NO is enhanced in human cirrhosis.</p> </sec> </abstract>