Document Detail


Effects of ursodeoxycholic acid on systemic, renal and forearm haemodynamics and sodium homoeostasis in cirrhotic patients with refractory ascites.
MedLine Citation:
PMID:  10209078     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systemic arterial vasodilatation has been implicated in the pathogenesis of sodium retention in cirrhosis. Hydrophobic bile acids, which have vasodilatory actions, may be involved. Ursodeoxycholic acid, a hydrophilic bile acid, could potentially decrease systemic arterial vasodilatation, possibly due to its antioxidant effects, and improve sodium handling in cirrhosis. The effects of ursodeoxycholic acid on systemic, renal and forearm haemodynamics, liver function and renal sodium handling were assessed in vasodilated cirrhotic patients with refractory ascites treated with a transjugular intrahepatic porto-systemic shunt (TIPS). Eight cirrhotic patients with refractory ascites without TIPS placement served as controls for the sodium handling effects of ursodeoxycholic acid. From 1 month post TIPS, seven patients were studied before, after 1 month of treatment with ursodeoxycholic acid (15 mg.day-1.kg-1) and at 1 month follow-up. Lipid peroxidation products were used as indices of its antioxidant effects. Ursodeoxycholic acid caused a significant reduction in sodium excretion in both groups (P<0.05). This, in the post-TIPS patients (urinary sodium excretion: 35+/-8 mmol/day at 1 month versus 93+/-21 mmol/day at baseline, P<0.05), was due to a significant increase in sodium reabsorption proximal to the distal tubule (P<0.05), without any significant changes in systemic, renal or forearm haemodynamics, or in liver function. No significant change in lipid peroxidation products was observed. We conclude that: (i) in cirrhotic patients with refractory ascites, ursodeoxycholic acid causes sodium retention, (ii) the abnormality in sodium handling in the post-TIPS cirrhotic patients appears to be the result of a direct effect on the proximal nephron, suggesting that factors other than systemic vasodilatation also contribute to sodium retention in cirrhosis, (iii) caution should be exercised in administering ursodeoxycholic acid in cirrhotic patients with ascites.
Authors:
F Wong; A Bomzon; J Allard; P Liu; L Blendis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  96     ISSN:  0143-5221     ISO Abbreviation:  Clin. Sci.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-06-10     Completed Date:  1999-06-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  467-74     Citation Subset:  IM    
Affiliation:
Department of Medicine, Toronto Hospital, University of Toronto, 200 Elizabeth Street, Toronto M5G 2C4, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Antioxidants / contraindications*,  therapeutic use
Ascites / metabolism,  physiopathology
Female
Forearm
Hemodynamics / drug effects*
Humans
Kidney / drug effects*,  physiopathology
Liver Cirrhosis / metabolism,  physiopathology*
Male
Middle Aged
Sodium / metabolism*
Ursodeoxycholic Acid / contraindications*,  therapeutic use
Chemical
Reg. No./Substance:
0/Antioxidants; 128-13-2/Ursodeoxycholic Acid; 7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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