Relationship between plasma arginine vasopressin and renal water handling in decompensated cirrhosis

Miner Electrolyte Metab. 1984;10(3):155-65.

Abstract

Although an impairment in renal water excretion is a commonly encountered clinical problem in cirrhotic patients, the mechanisms responsible for this abnormality are uncertain. ADH levels are elevated in some patients with decompensated cirrhosis, but a causal relationship between these levels and impaired water excretion has not been established. Since in normal man, water immersion to the neck (NI) results in a preferential central hypervolemia (CV), without plasma compositional change, and a resultant suppression of AVP, we designed the present study to determine if the diuretic response of cirrhotic patients to NI is mediated by a decrease in AVP. 17 cirrhotic patients with ascites were studied following 14 h of dehydration on two occasions: during a seated control study (C) and during 4 h of NI. AVP, determined by RIA, was measured every 30 min. 12 of the 17 patients manifested a diuresis that equalled or exceeded that documented in normal hydropenic subjects during immersion. NI did not alter mean AVP as compared with either the pre-study hour or those of the corresponding control study. Furthermore, peak V and CH2O varied independently of prestudy AVP (r = -0.116), mean change in AVP (r = -0.060), as well as nadir AVP levels (r = -0.122). The demonstration of a diuresis in some of the subjects, occurring without concomitant suppression of plasma AVP, suggests that ADH may constitute a permissive rather than pivotal factor in the impaired water excretion of many patients with advanced liver disease.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Arginine Vasopressin / blood*
  • Ascites / blood
  • Body Water / metabolism*
  • Creatinine / urine
  • Humans
  • Immersion
  • Kidney / metabolism*
  • Liver Cirrhosis, Alcoholic / blood
  • Liver Cirrhosis, Alcoholic / urine*
  • Male
  • Middle Aged
  • Osmolar Concentration
  • Potassium / urine
  • Renin / blood
  • Sodium / urine

Substances

  • Arginine Vasopressin
  • Sodium
  • Creatinine
  • Renin
  • Potassium