Hepatic hemodynamics and the renin-angiotensin-aldosterone system in cirrhosis.

Abstract The relationships between the renin-angiotensin-aldosterone system and sodium excretion, systemic, renal, and hepatic hemodynamics were studied in three groups of patients with cirrhosis of the liver. Group I included 22 patients with ascites and very low sodium excretion (3.8 ± 3.4 meq/day), group II, 14 patients with ascites and a relatively high sodium excretion (44.2 ± 22.0 meq/day), and group III, 18 patients without ascites or edema. Renin and aldosterone levels were significantly different in the three groups, the higher values being observed in group I. There was a significant inverse relationship between renin and aldosterone levels, and sodium excretion. No significant differences were observed between the three groups of patients in relation to plasma volume, cardiac output, and peripheral resistance, and no significant relationships were identified between systemic hemodynamic parameters and plasma renin levels. The renal plasma flow and glomerular filtration rate were slightly higher in compensated cirrhotics of group III, but no correlation was found between the renal perfusion and renin levels. The wedged hepatic vein pressure was significantly different in the three groups of patients. A close direct correlation was observed between the wedged hepatic vein pressure and plasma renin concentration and activity. These results suggest that the degree of stimulation of the renin-angiotensin-aldosterone system in cirrhosis is related to abnormalities in the hepatic hemodynamics.