Glucagon‐independent renal hyperaemia and hyperfiltration after an oral protein load in Child A liver cirrhosis

Abstract

The work was designed to study the effects of a meat meal on glomerular filtration rate (GFR), renal plasma flow (RPF), and plasma concentrations of glucagon, insulin, growth hormone, renin, aldosterone, total amino acids, and NH3 in healthy humans (H) as well as in patients with Child A liver cirrhosis (LC). The meat meal produced renal hyperaemia and hyperfiltration without changes in the filtration fraction. Fractional Na excretion in urine increased significantly after the meat meal only in LC. Hyperinsulinaemia and hyperglucagonaemia were seen at baseline in LC and were not affected by the meat meal, whereas in H glucagon concentration increased significantly over baseline within 30 min from the meat meal and insulin within 60 min. Growth hormone concentration was normal at baseline in LC and increased significantly 120-180 min after the meal, whereas it was not affected in H. Renin and aldosterone were stable in both H and LC. Plasma amino acid concentration began to increase 60 min after the meat meal, when hyperfiltration was present. The data indicate that in human Child A cirrhosis of the liver renal haemodynamic response to a meat meal is independent of changes in glucagon.

Renal Function in Compensated Hepatic Cirrhosis: Effects of an Amino Acid Infusion and Relationship with Nitric Acid

“…Changes in NO and cGMP plasma concentrations as [20,21] and Woitas et al [22]. However, other investigators have reported higher average GFR values in cirrhotic well as the urinary excretion values are summarized in table 2.…”

Creatinine Clearance: An Inadequate Marker of Renal Filtration in Patients with Early Posthepatitic Cirrhosis (Child A) without Fluid Retention and Muscle Wasting

“…GFR was measured as the inulin clearance performed with the constant-infusion technique of Walser et al [25], as described else where [9,21], Participants were admitted one at a time to the hospi tal at 8.30 a.m. exactly on the morning when B3 was drawn, after an overnight fast. Each participant received 20 ml/kg BW of water.…”

“…At 10.00 a.m., after 90-min equilibration, three clearance periods were obtained from each subject, each of 30-min duration (Ci, C2, C3), which were subsequently averaged. Blood and urine were analyzed for inulin by spectrophotometry [25], as described [9,21]. Inulin clearance was calculated by the standard formula as expressed per 1.73 m2.…”

“…A group of 19 patients with Child A [19][20][21] posthepatitic liver cirrhosis, established by liver biopsy, participated in the study after giving their informed consent. The study had been approved by the Health Board at the Medical Faculty.…”

“…It should be stressed, however, that patients studied in the previous reports had alcoholic cirrhosis [11][12][13][14], were usually ascitic [12,13], hypoalbuminémie, hyponatrémie [12,13,15], had prolonged prothrombin time [13] and hyperbilirubinemia from 5 mg/dl [13] to 41 mg/dl [15], Information is however lacking on the behavior of the ere-atinine-to-inulin clearance ratio in the very early stages of liver cirrhosis when patients are not edematous, have nor mal plasma concentration of albumin and aldosterone, are not hyponatrémie, their plasma renin activity falls within normal limits, there is no prolongation of pro thrombin time, and creatinine clearance is normal, as is the case with Child A liver cirrhosis [19][20][21].…”