Renal Circulation in Cirrhosis: Observations Based on Catheterization of the Renal Vein*

In patients with cirrhosis and advanced hepatic failure, impairment of renal function with subse-quent oliguria and azotemia may develop in the absence of primary renal disease; the prognosis when this complication occurs is grave (1-7). In recent reports, we have defined some of our experiences with patients in hepatic and renal failure (7, 8). The observations of others (3-5; 9-11) and ourselves (8) suggest that reduction in effective renal plasma flow (ERPF), develop-ing particularly in patients with severe impair-ment of hepatic function and relatively resistant ascites, is the most important factor leading to renal complications. Previous estimations of renal circulatory func-tion (ERPF) in such patients have been based on para-aminohippurate (PAH) clearance alone (3, 9, 10), which may correlate poorly with renal plasma flow when renal function is severely im-paired (12). In addition, the pathophysiologic mechanisms that may reduce renal hemodynamic function in hepatic disease have not been investi-gated comprehensively. Reductions in "effective" blood volume (2, 4, 13), peripheral vascular re-sistance (6), or arterial blood pressure (1, 3, 6) have been postulated in this regard. The purposes of the present study were to de-termine renal plasma flow in patients with cirrho-sis and associated impairment of renal function