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Hemodynamic, renal, and endocrine effects of acute inhibition of nitric oxide synthase in compensated cirrhosis
Author(s) -
La Villa Giorgio,
Barletta Giuseppe,
Pantaleo Pietro,
Del Bene Riccarda,
Vizzutti Francesco,
Vecchiarino Sabrina,
Masini Emanuela,
Perfetto Federico,
Tarquini Roberto,
Gentilini Paolo,
Laffi Giacomo
Publication year - 2001
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2001.25756
Subject(s) - medicine , hyperdynamic circulation , plasma renin activity , endocrinology , renal sodium reabsorption , vascular resistance , omega n methylarginine , renal blood flow , nitric oxide , cyclic guanosine monophosphate , renal function , hemodynamics , nitric oxide synthase , blood pressure , kidney , renin–angiotensin system , reabsorption
To assess whether an increased production of nitric oxide is involved in the circulatory and renal alterations of cirrhosis, we evaluated systemic hemodynamics (echocardiography), renal hemodynamics, and sodium handling (lithium clearance method), plasma renin activity (PRA), aldosterone (PAC), and norepinephrine in 7 patients (3 men, mean age 65 ± 2 years) with compensated cirrhosis, portal hypertension, and hyperdynamic circulation during intravenous N G ‐monomethyl‐ L ‐arginine (L‐NMMA) (3 mg/kg bolus plus 0.05 mg/kg · min for 120 minutes) or placebo (the vehicle) in a randomized, placebo‐controlled, crossover study. Administration of L ‐NMMA resulted in significant reductions in plasma and urinary nitrite levels and plasma cyclic guanosine monophosphate (cGMP), indicating effective inhibition of nitric oxide synthase. L ‐NMMA also significantly reduced cardiac index (−13%) and increased systemic vascular resistance (+26%), arterial pressure (+9%), renal blood flow (+12%), glomerular filtration rate (+12%), and sodium excretion (+25%). Changes in sodium excretion were caused by both enhanced filtered sodium load and reduced sodium reabsorption in the proximal tubule. Plasma norepinephrine significantly decreased in response to L ‐NMMA, and there was a trend for reductions in PRA and PAC. Placebo had no appreciable effect on any of the measured parameters. These results indicate that in patients with compensated cirrhosis, portal hypertension and hyperdynamic circulation inhibition of nitric oxide synthase corrects the altered systemic hemodynamics and improves renal function and sodium excretion.