Renal function in cirrhosis and the effects of prostaglandin A 1

Abstract

Renal and hepatic function were studied in 20 patients with cirrhosis and ascites, before and during infusion of prostaglandin A 1 (PG-A 1), and in 7 patients during infusion of furosemide, with and without PG-A 1. Liver function was evaluated by using 10 clinically related criteria to determine a liver function profile. A significant negative correlation was found between the liver function profile and both glomerular filtration rate (GFR) (r = −0.74, p < 0.01) and effective renal plasma flow (ERPF) (r = −0.71, p < 0.01). Patients were then grouped according to their ERPF: Group I (450 ml/min), group II (150 to 450 ml/min) and group III (< 150 ml/min). During PG-A 1 infusion, ERPF increased significantly only in groups I and II, by (±SE) 138 ± 67 ml/min and 131 ± 40 ml/ min, respectively. The GFR and sodium excretion also increased only in groups I and II. During furosemide infusion, there were highly significant increases in urine volume and sodium excretion but no consistent change in either GFR or ERPF. The effects of PG-A 1 and furosemide were not additive. The results show that in cirrhotic patients with ascites, PG-A 1 infusion can significantly increase both GFR and ERPF in all patients but those with the most severe liver impairment. Furosemide consistently increased urine volume and sodium excretion but did not affect GFR or ERPF. Both GFR and ERPF could be related to the extent of hepatic impairment by means of a liver function profile.