Role of Renal Kallikrein in the Derangement of Sodium and Water Excretion in Cirrhotic Patients

Abstract

The renal kallikrein-kinin system is involved in the regulation of intrarenal blood flow and natriuresis. To study whether deranged sodium and water excretion in terminal cirrhosis is associated with an altered renal kallikrein-kinin system, urinary kallikrein excretion (U_kalV) was measured. Low U_kalV excretion was found in cirrhosis. In particular, nine cirrhotics with ascites showed a significantly lowered ratio of U_kalV to urinary aldosterone excretion when compared with eight cirrhotics without ascites. Continuous infusion in cirrhosis and ascites of prostaglandin E₁ (0.1 ng/kg/min) for 3 days resulted in marked increases in both daily urine volume and urinary sodium excretion; this was associated with a significant elevation of U_kalV. These results suggest that in cirrhosis the impairment in renal sodium and water excretion may be attributed, at least in part, to deficient activation of the renal kallikrein-kinin system.

Key words:

• Cirrhosis
• renal kallikrein-kinin system