Renal Failure in Laennec's Cirrhosis. Ii. Simultaneous Determination of Cardiac Output and Renal Hemodynamics*

Renal Circulation in Cirrhosis: Observations Based on Catheterization of the Renal Vein*

“…Lancestremere and his colleagues (35) found that the cardiac output was normal or elevated under such circumstances, and our results showed that the cardiac output was usually within the normal range. There could have been a small reduction of doubtful relevance from previous values, however, as higher measurements were obtained in group I patients.…”

Systemic and Renal Hemodynamics in Oliguric Hepatic Failure: Effect of Volume Expansion*

“…While azotemia usually was present at the time of death, the major terminal event was more often gastrointestinal hemorrhage or hepatic coma. Discussion Previous investigators, using the PAH clearance method (4,5,15,16), have found reduced RBF in patients with hepatic failure. However, clearance techniques may be inaccurate in the oliguric patient.…”

“…While reduced renal perfusion may not be the only factor in the oliguria of severe liver disease, a number of investigators have considered this reduction of prime importance (4,5). That renal vasoconstriction contributes to the low RBF in these patients was confirmed by the finding of high renal vascular resistance and a markedly reduced renal fraction of CO.…”

“…The absence of a history of kidney disease or of a specific histological renal lesion has led to the suggestion that the renal failure may be due to decreased renal perfusion (3), and clearance studies have suggested that renal blood flow is severely reduced (4,5). However, the mechanism of the renal hemodynamic abnormality in this syndrome has not been established.…”

Acute Changes in Renal Excretion of Water and Solute in Patients With Laennec's Cirrhosis, Induced by the Administration of the Pressor Amine, Metaraminol*

“…Further inquiry demonstrated that the observed reduction in glomerular filtration rate (GFR) and renal plasma flow, under these conditions, was not attributable to diminished cardiac output, but rather occurred in the face of an increased cardiac output (4). Diminished GFR and renal plasma flow when cardiac output is increased suggests a decrease in extrarenal peripheral resistance with or without an increase in renal resistance (5) or circulatory shunting of some of the nephrons.…”