The Role of Arachidonic Acid Metabolites in the Functional Renal Impairment Associated with Liver Disease
There are many morphologic and functional abnormalities of the kidney associated with liver disease. Both organs may be simultaneously affected by toxic agents such as carbon tetrachloride, by infections such as leptospirosis or generalized sepsis, and by metabolic changes such as hypoxia or shock. In addition, there are several well-described glomerulonephropathies such as those associated with hepatitis B infection, tubular abnormalities including renal tubular acidosis in chronic liver disease, and several genetic and neoplastic diseases. Among the more enigmatic associations are the functional changes in renal hemodynamics and sodium and water excretion that occur during the course of severe liver disease.1 These abnormalities are considered functional because anatomic changes have not been identified and because renal function is normal on successful transplantation to an unaffected recipient.2 In their most extreme phase the functional abnormalities progress to renal failure (hepatorenal syndrome) characterized by oliguria, intense sodium retention, and extensive vasoconstriction of the outer segments of the renal cortex.3 Although a number of liver disorders may be associated with renal failure, it is most common in patients with cirrhosis and ascites. Because of the functional nature of the renal impairment, there have been many studies of different vasoactive systems in patients with cirrhosis and ascites.
KeywordsRenal Blood Flow Sodium Retention Severe Liver Disease Hepatorenal Syndrome Arachidonic Acid Metabolite
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