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South African Medical Journal

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Renal function, sodium and water homeostasis in patients with idiopathic extrahepatic portal vein thrombosis compared with normal healthy controls

Brian L. Rayner, Simon C. Robson, Ralph E. Kirsch, Michael Voigt

Abstract


Objectives. To determine whether portal hypertension in the absence of liver disease contributes to changes in renal function and renal sodium and water handling.

Methods. Nine patients with extrahepatic portal vein thrombosis (PVT) with normal liver function and histology were compared with 9 matched healthy control subjects. All underwent standard measurements of glomerular filtration rate and effective renal blood flow using inulin and paraaminohippuric acid (PAH) clearances, respectively. Sodium excretion and renin and aldosterone levels were studied before, during and after an intravenous saline infusion,

Results. At baseline there were no differences in inulin clearance, PAH clearance, fractional excretion of sodium and free water excretion. During and after the saline infusion both groups showed a significant increase in sodium excretion with a reduction in water excretion, while the PAH and inulin clearances remained unchanged. Although aldosterone and renin levels both fell after the infusion, aldosterone levels were significantly lower in the PVT group. There were no other significant differences between the PVT and control groups.

Conclusion. Renal function and sodium and water handling were comparable in healthy controls and patients with PVT. It is unlikely that portal hypertension alone plays a significant role in the impaired ability to excrete sodium and water in patients with liver cirrhosis




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