Re: Renin secretion and cirrhosis

From:        SereneCowWithCJD
Date:        25 Jun 2005
Time:        17:28:56 +1100
Remote Name: 203.122.141.140

Comments:

Whoops - pressed enter twice :)

My Apologies..

Now to the 'anonymous' person who didn't even want to submit their name, and the
_highly useful_ comment of "bollox", I say this:
- If you feel that you have any sort of informed opinion at all, please elaborate. And in
future, have the guts to submit a name of sorts. It is easy to sit on the side in life and
take pot shots at those who are trying. Just remember that you were perhaps a senior
resident or junior registrar, and you turned to other people for help. How would you
have felt if they just walked up to you, sneered in your face and said Bollocks???? I hope I
have made my point.

Now back to the original post :) Working at the Austin in Melbourne we do a lot of work
with fulminant hepatic failure patients as well as those awaiting or who have
received a liver transplant.

Chronic liver disease is associated with hyperaldosteronism, and hence by its root, an
increased supply of renin. This is the reason that spironolactone is often used as
treatment for the ascites that accumulates. My understanding is this:

1. Chronic liver disease - decreased generation of oncotic proteins, particularly
albumin. Hence less intravascular volume, which is sensed by the kidneys as a
relative volume deficiency, hence increased renin production.
2. Chronic liver disease is also associated with a decrease in systemic vascular
resistance. This is postulated to be due to decreased hepatic clearance of a number of
molecules which act as vasodilators, particularly nitrogen based compounds.
3. Chronic liver disease patients show capillary autoregulatory defects, due to a
decrease in lactate metabolism and other metabolites, hence implying that there is a
capillary based vasodilation also.

So, the combination of systemic vasodilation, capillary bed vasodilation and an
increased 'leakiness' of the vascular compartment means there is a relative
hypovolaemic state. Hence the effect of renin.

Just a few cents worth.

Cheers
SereneCowWithCJD