Acute effects of peritoneovenous shunting on plasma atrial natriuretic peptide in cirrhotic patients with massive refractory ascites

Campbell, Peter J.; Skorecki, Karl; Logan, Alexander G.; Wong, Pui-Yuen; Leung, Wai Ming; Greig, Paul D.; Blendis, Laurence M.

doi:10.1016/0002-9343(88)90017-4

Cited by 50 publications

(14 citation statements)

References 28 publications

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“…High plasma irANF levels in the present and other patient groups [14][15][16][17][18] as opposed to normal values in certain previous reports [11][12][13][14] may at least in part reflect different stages and/or treatment of liver cirrhosis. Plasma irANF values were sometimes not differentiated relative to the presence or absence of ascites or were obtained during diuretic treatment [11,13,16].…”

Section: Discussioncontrasting

confidence: 64%

“…In humans, plasma ANF levels increase in response to volume ex pansion [4,5], the central shift of blood volume with changes from upright to supine position [6] or acute rises in arterial blood pressure (BP) [7], On the other hand, synthetic a-human ANF (a-hANF) infused intrave- nously can produce an extravascular shift of plasma fluid [8], enhance diuresis and natriuresis [8,9], inhibit aldo sterone production [9,10] and lower BP [8][9][10], In patients with liver cirrhosis complicated by ascites, plasma immunoreactive (ir) ANF levels have variably been reported as normal [11][12][13][14] or increased [15][16][17][18]. The diuretic and natriuretic response to pharmacological doses of a-hANF was also evaluated in some cirrhotic patients [19][20][21], but renal plasma flow and glomerular filtration rate (GFR) were not measured.…”

Section: Introductionmentioning

confidence: 99%

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Hypotension and Renal Impairment during Infusion of Atrial Natriuretic Factor in Liver Cirrhosis with Ascites

Ferrier¹,

Beretta-Piccoli²,

Weidmann³

et al. 1989

Am J Nephrol

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Plasma immunoreactive atrial natriuretic factor (irANF) levels and the effects of α-human ANF (α-hANF) infusion were investigated in 7 patients with liver cirrhosis and ascites. Under basal conditions, supine blood pressure (BP) averaged 136/76 ± 9/4 mm Hg (mean ± SEM). Plasma irANF concentrations (124 ± 33pg/ml)were higher (p < 0.01) than those in age-matched normal subjects (47 ± 5 pg/ml). Plasma renin activity (PRA 5.9 ± 2.2 ng/ml/h), aldosterone (18 ± 7 ng/dl) and norepinephrine (NE, 66 ± 5 ng/dl) levels were also elevated compared to the age-related normal range. α-hANF infusion for 60 min at 0.036 μg/kg/min decreased the mean BP (-14%; p < 0.05), increased PRA (+179%; p < 0.05) and plasma NE (+24%; p < 0.05). Glomerular filtration rate (GFR), effective renal plasma flow (ERPF), diuresis and natriuresis were not modified. A subsequent 60-min infusion of α-hANF at 0.067 μg/kg/min produced a marked fall in mean BP (-26%; p < 0.001), hemoconcentration (hematocrit + 6%; p < 0.001) despite stable body fluid balance and a further increase in PRA (+350%, p < 0.005). GFR and ERPF were severely reduced (-55 and -56%, respectively; p < 0.001), while diuresis and natriuresis were not modified. Plasma aldosterone was unaltered during, but rose (+72%; p < 0.01) after the cessation of α-hANF infusion. Variations in natriuresis during α-hANF infusion correlated positively with BP (r = 0.47; p < 0.01), ERPF (r = 0.53; p < 0.01) or GFR (r = 0.51; p < 0.01). These findings indicate that in patients with liver cirrhosis and ascites, plasma levels of circulating irANF are increased. Infusion of α-hANF in pharmacological doses can produce unwanted falls in BP, ERPF and GFR which, in turn, preclude a therapeutically desired renal excretory response.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Hypotension and Renal Impairment during Infusion of Atrial Natriuretic Factor in Liver Cirrhosis with Ascites

Ferrier¹,

Beretta-Piccoli²,

Weidmann³

et al. 1989

Am J Nephrol

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“…In contrast to the observations of Campbell et al [20], Klepetko et al [50] failed to discern a direct relationship between changes in ANF and sodium excretion. They demonstrated that the heterogeneity that characterized the natriuretic responses during immersion [21a, 30] was also observed following PV shunting [50].…”

Section: Peritoneovenous Shuntingmentioning

confidence: 71%

“…Based on their studies, Campbell et al [20] concluded that in patients with refractory ascites there is no defect in ANF release or in its biochemical activity as assessed at the level of cGMP signalling.…”

Section: Peritoneovenous Shuntingmentioning

confidence: 99%

Atrial Natriuretic Factor in Patients with Liver Disease

Epstein

1989

Am J Nephrol

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“…Following intravenous reinfusion of ascites elevated ANF plasma levels have been reported (3,4,5). This might be due to ANF re lease stimulated by the hemodynamic changes following ascites infusion or due to elevated ANF concentrations in ascitic fluid.…”

mentioning

confidence: 99%