Effect ofportacaval anastomosis onrenal blood flowincirrhosis- preliminary results

Summary Theestablished end-to-side portacaval shuntisnot effective innormalizing thedecreased renal blood flow inpatients with cirrhosis oftheliver. Theability ofthe side-to-side shunt tooffer this effect remains tobe decided, andwill besowhenpatients withthis typeof shunt areaddedtothis study. FUNCTIONAL renalfailure isa frequent andimportant complication ofliver failure. Theclinical features ofthesyndrome arewell characterized but theaetiology still remains apuzzle. Thattheconditionisindeed functional hasbeenproved bythe reversibility oftheimpairment ofrenal function by transplantation ofsuchkidneys torecipients without liver disease (Koppel etal., 1969) andrecently bythe transplantation ofhealthy livers topatients with liver failure complicated withimpairment ofrenal function ofthepresent nature (Iwatsuki etal., 1974). In this latter condition thepatient's ownkidneys regain normal function. Therenal hypoperfusion asaconsequence ofan active renal vasoconstriction seemstobethekeystoneinthepathogenesis offunctional renal failure (FRF)incirrhosis. However, inthecirrhotic patient withascites andoedemabutwithout renal failure, therenal blood flowisoften decreased although toa minordegree. Evenincirrhotic patients without clinical signs ofsodium andwater retention therenal perfusion isless thanincontrols. Recently, similar hypoperfusion ofthekidneys hasbeenfound tobe present inpatients withextrahepatic portal hyper