Characteristic of renal response to the salt-loading test in patients with decompensated liver cirrhosis

Abstract

Edema-ascitic syndrome is one of the clinical manifestations of decompensation of liver cirrhosis (LC) in the development of which an essential role belongs to renal dysfunction with disturbance of water-electrolyte metabolism. The purpose of our study was to study the function of the kidneys in conditions of spontaneous diuresis and during the salt load in this category of patients. 21 patients with a low-active decompensated LC of toxic etiology at the age of 32 to 68 years and 18 practically healthy people were examined. The functional state of the kidneys was assessed by the clearance method under conditions of a 12-hour spontaneous night and 2-hour induced diuresis (using 0.5% sodium chloride solution at a rate of 5 ml / kg body weight). Impaired renal function in spontaneous diuresis was manifested by a slight increase in the concentration of blood creatinine (p <0.05) with virtually unchanged glomerular filtration (GF), a tendency to decrease sodium ion excretion due to a decrease GF. During the salt load, a decrease in adaptive reactions of the kidneys to the introduction of a saline solution was found: a decrease in both total and relative diuresis (p <0.05), an increase in the plasma creatinine concentration (p <0.05) with a decrease in GF almost 3 time. Changes in the ion-regulating function of the kidneys were characterized by a decrease in the excretion of sodium and potassium in the urine (p <0.05) with a predominant violation of sodium excretion. Thus, in patients with decompensated LC, disturbances in the water-electrolyte balance can be caused by a decrease GF with a violation of excretion of sodium and water ions, which clearly manifest themselves against the background of the salt load. These violations are of a functional nature, since they arise in response to small volumes of liquid in a short period of time.