Kallikrein-Kinin and Renin-Angiotensin Systems in Functional Renal Failure of Cirrhosis of the Liver

Abstract

Bradykinin and angiotensin II are potent mammalian hormones with opposite actions on renal vessels. The possibility that abnormal kallikrein-kinin and renin-angiotensin systems may be responsible for functional renal failure was investigated. Fifteen patients ranging in age from 27 to 60 years with cirrhosis of the liver were studied. Seven of these patients (controls) were chosen because of persistent ascites, prothrombin time of more than 3 sec above controls, normal blood urea nitrogen and serum creatinine. The remaining 8 patients had hepatorenal syndrome (HR syndrome). All patients had been on a low sodium (less than 10 mEq per 24 hr) diet from 5 to 6 days. Fasting, supine, overnight blood samples were then drawn between the hours of 8 and 10 am. The mean plasma prekallikrein as determined by tosyl arginine methyl ester (TAMe) esterase method for control patients was 11.6 ± 2.8, whereas that of the HR group was 2.5 ± 1 μmoles per ml-hr, P