Document Detail

The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt.
MedLine Citation:
PMID:  9041252     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: The pathogenesis of the delayed natriuresis after transjugular intrahepatic portosystemic shunt (TIPS) insertion is unknown. This was studied to elucidate the mechanism involved. METHODS: In 12 patients with cirrhosis and refractory ascites after TIPS, systemic and renal hemodynamics, renal sodium handling, central blood volume, neurohumoral factors, and hepatic function were studied weekly after the shunt with the patients receiving a diet of 20 mmol sodium/day. RESULTS: Two weeks after TIPS, the initial natriuresis (4 +/- 1 to 18 +/- 3 mmol/day; P < 0.05) was associated with significant reductions in corrected sinusoidal pressure (24.4 +/- 1.8 to 7.5 +/- 0.4 mm Hg; P < 0.001), proximal renal tubular reabsorption of sodium (P = 0.05), and renin-angiotensin-aldosterone activity (P < 0.05), but with significant systemic vasodilatation (P < 0.05). At 4 weeks, negative sodium balance was achieved (52 +/- 21 mmol/day; P < 0.01), despite continued systemic arterial vasodilatation, associated with significant increases in total central and cardiac volumes (P < 0.05) and normalization of serum aldosterone levels (P < 0.01). Four late responders were significantly older (P = 0.01) and had significantly lower baseline glomerular filtration rates (P = 0.02). CONCLUSIONS: In cirrhosis, sinusoidal portal hypertension and an activated renin-angiotensin-aldosterone system seem to be important in the pathogenesis of sodium retention. Systemic vasodilatation without arterial underfilling does not prevent natriuresis. Delayed natriuresis after TIPS is associated with increasing age and pre-TIPS renal impairment.
F Wong; K Sniderman; P Liu; L Blendis
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gastroenterology     Volume:  112     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-03-20     Completed Date:  1997-03-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  899-907     Citation Subset:  AIM; IM    
Department of Medicine, University of Toronto, Ontario, Canada.
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MeSH Terms
Aldosterone / blood
Kidney / physiopathology
Liver / physiopathology
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic / adverse effects*
Renin / blood
Sodium / metabolism
Reg. No./Substance:
52-39-1/Aldosterone; 7440-23-5/Sodium; EC

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