This study was presented in poster form both at the World Congress of Gastroenterology (WCOG), Bangkok, Thailand, February–March 2002 and at the at the 37th Annual Meeting of the European Association for the Study of the Liver (EASL), Madrid, Spain, April 2002. It was also presented in oral form at the United European Gastroenterology Week (UEGW) which took place in Geneva, Switzerland, October 2002.
Evidence of a dynamic aldosterone-independent distal tubular control of renal sodium excretion in compensated liver cirrhosis*
Version of Record online: 14 MAR 2005
Journal of Internal Medicine
Volume 257, Issue 4, pages 358–366, April 2005
How to Cite
SANSOÈ, G., SILVANO, S., ROSINA, F., SMEDILE, A. and RIZZETTO, M. (2005), Evidence of a dynamic aldosterone-independent distal tubular control of renal sodium excretion in compensated liver cirrhosis. Journal of Internal Medicine, 257: 358–366. doi: 10.1111/j.1365-2796.2005.01459.x
- Issue online: 14 MAR 2005
- Version of Record online: 14 MAR 2005
- lithium clearance;
- liver cirrhosis;
- sodium metabolism;
- upright posture
Background and aim. In preascitic cirrhosis increased sodium retention occurs in kidney distal tubule in spite of normal aldosterone plasma levels. No clearance technique can dissect the respective contribution to sodium retention exerted by Henle's loop, distal convoluted tubule and collecting duct, so we evaluated proximal and distal tubular sodium handling in preascites during two manoeuvres that temporarily increase aldosterone secretion.
Methods. Ten patients with compensated cirrhosis and nine controls were studied in recumbency, during standing and after dopamine receptor blockade with metoclopramide through: 4 h renal clearances of sodium, potassium, lithium and creatinine; plasma levels of active renin and aldosterone.
Results. Whilst comparable in recumbency, aldosterone levels significantly rose during standing and after metoclopramide in both groups. In patients, dopaminergic blockade caused a fall of distal sodium delivery (P < 0.01) but urinary sodium excretion was unchanged because the reabsorbed fraction of distal sodium delivery also fell (P < 0.03). Cirrhotic patients showed the same findings in the passage from recumbency to standing.
Conclusions. In preascitic cirrhosis, the distal tubular segments of the nephron are able to cope with decreases in tubular flow by reducing reabsorption at an aldosterone-independent site (possibly the loop of Henle).