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Cirrhotic Patients Benefit From Nitric-Oxide Stimulation
A DGReview of :"Systemic nitric oxide production and renal function in nonazotemic human cirrhosis: a reappraisal"
American Journal of Gastroenterology
10/14/2002
By Robert Short
Reduction in kidney function can be delayed in compensated cirrhotic patients by stimulation of systemic nitric oxide production and increased dopaminergic function.
This was the finding of a study of 21 patients with cirrhosis and 10 healthy control subjects. Eleven of the subjects in the patient group had pre-ascitic cirrhosis and 10 had nonazotemic diuretic-free ascitic cirrhosis.
Nitric oxide plasma values and endogenous dopaminergic activity were significantly increased with respect to healthy controls. However, they were not different in the two groups of patients. The plasma nitric-oxide/plasma-renin-activity ratio was significantly higher in the group of compensated patients with respect to ascitic cirrhotics. Compared with compensated cirrhotics, patients with ascites showed significantly lower values of glomerular filtration rate and renal plasma flow.
Dr G Sansoč said, "Interestingly, glomerular filtration rate values were substantially the same in the ascitic patients and the control subjects". Dr Sansoč is based at the Gastroenterology Unit, Gradenigo Hospital, Torino, Italy.
The compensated patients showed a significant positive correlation between metoclopramide-induced incremental aldosterone plasma levels (indicating endogenous dopamine tone) and fractional excretion of sodium. In the group of compensated patients, nitric oxide levels correlated inversely with creatinine plasma concentrations and directly with inulin clearance.
Dr Sansoč concluded, " These data show that, at least in compensated cirrhotic patients, the stimulation of systemic nitric oxide production and the increased dopaminergic function may be mechanisms preventing renal perfusion, glomerular filtration rate, and fractional excretion of sodium from precocious reductions".
American Journal of Gastroenterology 2002;97(9):2383-2390
"Systemic nitric oxide production and renal function in nonazotemic human cirrhosis: a reappraisal"
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