Role of atrial natriuretic peptide in the natriuretic response to central volume expansion induced by head-out water immersion in sodium-retaining cirrhotic subjects

Skorecki, Karl; Leung, Wai Ming; Campbell, Peter J.; Warner, Leonard C.; Wong, P. Y.; Bull, Shelley B.; Logan, Alexander G.; Blendis, Laurence M.

doi:10.1016/0002-9343(88)90590-6

Cited by 74 publications

(24 citation statements)

References 27 publications

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“…Thus, the response of circulating plasma ANF to immersion-induced central hypervolemia is clearly not depressed in cirrhosis, but rather appears to be normal or exaggerated. As detailed in the review in this issue, these Findings are in accord with the recent observations of Skorecki et al [21].…”

Section: Discussionsupporting

confidence: 90%

Relationship between Plasma ANF Responsiveness and Renal Sodium Handling in Cirrhotic Humans

et al. 1989

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The responsiveness of atrial natriuretic factor (ANF) to central volume expansion and its role as a determinant of the natriuretic and diuretic responses of cirrhotic patients was evaluated utilizing water immersion (WI). Following equilibration on a 10-mEq sodium diet, 9 seated cirrhotic patients were studied during 3 h of WI. Before WI, plasma ANF levels (10.9 ± 2.4 fmol/ml) were similar to those previously observed in normal sodium-replete subjects (7.7 ± 0.9 fmol/ml). Five of the 9 cirrhotic subjects manifested an exaggerated peak ANF response, whereas the remaining 4 manifested increases similar to those of normals. The concomitant natriuretic response varied widely, ranging from absent to markedly exaggerated responses. The peak urinary sodium excretion varied independently of peak plasma levels of ANF and peak change of ANF from the prestudy hour (r = 0.36, p > 0.20, and r = 0.46, p > 0.20, respectively). Thus, in contrast to normal subjects, in whom the immersion-induced natriuresis correlated closely with the changes in ANF, the natriuretic responses of cirrhotic patients were dissociated from the concomitant increases in ANF. These observations indicate that sodium retention in cirrhosis is not attributable to impaired ANF release.

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Section: Discussionsupporting

confidence: 90%

Relationship between Plasma ANF Responsiveness and Renal Sodium Handling in Cirrhotic Humans

et al. 1989

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“…This phenomenon cannot be explained by the existence of a modified or less biologically active peptide in cirrhosis (17,38). Moreover, the responsiveness of plasma ANP and urinary cGMP excretion is intact; both increase in parallel after experimental volume expansion such as head-out water immersion (10,34), saline infusion (36), and peritoneovenous shunting (7,19) or decrease in parallel in response to diuretic-induced volume contraction (16). The exact mechanism(s) for this ANP resistance has not been established but may involve a mechanism at the postreceptor level or an increased activation of antinatriuretic systems like the renin-angiotensinaldosterone system (RAAS) and the sympathetic nervous system (25,37).…”

mentioning

confidence: 99%

Inhibition of cGMP-specific phosphodiesterase type 5 reduces sodium excretion and arterial blood pressure in patients with NaCl retention and ascites

Thiesson

Jensen

Jespersen

et al. 2005

American Journal of Physiology-Renal Physiology

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In the present study, we tested the hypothesis that inhibition of renal phosphodiesterase type 5 (PDE5) in patients with liver cirrhosis and ascites increases sodium excretion. The effect of sildenafil citrate was studied in a randomized double-blind. placebo-controlled crossover study. Diuretics were withdrawn, and a fixed sodium diet (100 mmol/day) was given to the patients for 5 days before both study days. After a 60-min basal period, eight patients received either oral sildenafil (50 mg) or placebo. Glomerular filtration rate (GFR) and renal blood flow (RBF) were determined by 99mTc-diethylenetriamine-pentaacetate and (131)I-hippuran clearances. In human nephrectomy specimens, PDE5 mRNA was expressed at similar levels in the cortex (n = 6) and inner medulla (n = 4). Histochemical staining showed PDE5 immunoreactivity in collecting ducts and vascular smooth muscle. At baseline, cirrhotic patients exhibited elevated plasma concentrations of ANP, renin, ANG II, and aldosterone that did not differ on the 2 study days. Basal sodium excretion was similar at the 2 study days (median 17 and 18 mmol, respectively), and patients were in positive sodium balance. Sildenafil increased heart rate, plasma renin activity, plasma ANG II, and aldosterone concentrations significantly after 60 min. Plasma cGMP concentration was increased after 120 and 180 min, and urinary sodium excretion and mean arterial blood pressure were decreased significantly at 120 and 180 min. Plasma ANP concentration, GFR, and RBF did not change after sildenafil. In patients with ascites and cirrhosis, inhibition of PDE5 did not promote natriuresis but led to increased plasma levels of the renin-angiotensin-aldosterone system.

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“…central circulation time; hyperdynamic circulation; lean body mass; peripheral vasodilatation; portal hypertension; systemic vascular resistance IN PATIENTS WITH CIRRHOSIS, peripheral and splanchnic arterial vasodilatation leads to a hyperdynamic circulation with increased cardiac output (CO) and heart rate and an abnormal distribution of the blood volume (4, 19). The total blood and plasma volumes are increased and abnormally distributed with an increase in the noncentral or peripheral blood volume (2,12,21,23,30). The size of the central and arterial blood volume (CBV), which represents the effective blood volume where baro-and volume receptors are located, has been the subject of debate (7,23,31).…”

mentioning

confidence: 99%

“…The total blood and plasma volumes are increased and abnormally distributed with an increase in the noncentral or peripheral blood volume (2,12,21,23,30). The size of the central and arterial blood volume (CBV), which represents the effective blood volume where baro-and volume receptors are located, has been the subject of debate (7,23,31).…”

mentioning

confidence: 99%

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Möller¹,

Henriksen²,

Bendtsen

2003

American Journal of Physiology-Gastrointestinal and Liver Physi

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.-The size of the central and arterial blood volume (CBV) is essential in the understanding of fluid retention in cirrhosis. Previously, it has been reported decreased, normal, or increased, but no reports have analyzed CBV with respect to gender and lean body mass. The aim of the present study was by means of an optimized technique to reassess it in a large group of patients with cirrhosis compared with healthy controls and matched controls in relationship to their body dimensions and gender. Eighty-three patients with cirrhosis (male/female, 60:23), 67 patients without liver disease (male/ female, 22:45), and 14 young healthy controls (male/female, 6:8) underwent a hemodynamic investigation with determination of cardiac output, central circulation time, and CBV determined according to kinetic principles. Related to gender, CBV was lower in male cirrhotics (1.48 Ϯ 0.30 liter) than in matched and young controls (1.68 Ϯ 0.33 and 1.72 Ϯ 0.33 liter, respectively; P Ͻ 0.05-0.01). No significant differences in CBV were seen between female cirrhotics and controls. Absolute and adjusted CBVs were lower in the females than in men with cirrhosis (P Ͻ 0.001), and men with cirrhosis had lower absolute and body weight-adjusted CBVs than matched controls (P Ͻ 0.01). Normalized values of CBV (%total blood volume) were significantly lower in patients with cirrhosis (25 Ϯ 4%) than in matched controls (31 Ϯ 7%) and young controls (28 Ϯ 4%; P Ͻ 0.02). CBV correlated significantly with anthropometrics, including lean body mass (r ϭ 0.68-0.82; P Ͻ 0.0001). In conclusion, the CBV of patients with cirrhosis was lower than that of controls when adjusted for body dimensions and gender. There are significant gender differences, and signs of underfilling are more pronounced in male than in female patients. The results emphasize the importance of adjustments of blood volumes for anthropometrics and gender. central circulation time; hyperdynamic circulation; lean body mass; peripheral vasodilatation; portal hypertension; systemic vascular resistance IN PATIENTS WITH CIRRHOSIS, peripheral and splanchnic arterial vasodilatation leads to a hyperdynamic circulation with increased cardiac output (CO) and heart rate and an abnormal distribution of the blood volume (4, 19). The total blood and plasma volumes are increased and abnormally distributed with an increase in the noncentral or peripheral blood volume (2,12,21,23,30). The size of the central and arterial blood volume (CBV), which represents the effective blood volume where baro-and volume receptors are located, has been the subject of debate (7,23,31). According to the peripheral arterial vasodilatation theory, central hypovolemia leads to a baroreceptor-induced activation of fluid-retaining mechanisms and the development of ascites (4, 26). The alternative overflow theory holds that central and peripheral hypervolemia leads to spill-over of fluid into the peritoneal cavity and thereby the formation of ascites (15). When kinetic principles were applied, earlier results from our laboratory...

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Role of atrial natriuretic peptide in the natriuretic response to central volume expansion induced by head-out water immersion in sodium-retaining cirrhotic subjects

Cited by 74 publications

References 27 publications

Relationship between Plasma ANF Responsiveness and Renal Sodium Handling in Cirrhotic Humans

Relationship between Plasma ANF Responsiveness and Renal Sodium Handling in Cirrhotic Humans

Inhibition of cGMP-specific phosphodiesterase type 5 reduces sodium excretion and arterial blood pressure in patients with NaCl retention and ascites

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

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