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The Vicious Cycle of Chronic Congestive Heart Failure. Spironolactone. Overflow and Underfilling Hypotheses of Sodium and Water Retention in Cirrhosis. PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS. Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume.
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Overflow and Underfilling Hypotheses of Sodium and Water Retention in Cirrhosis
PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume COMPENSATED CIRRHOSIS (No Ascites) DECOMPENSATED CIRRHOSIS (Ascites) Hepatorenal Syndrome Normal
“I have ascites and have desire for water, Although I know this water will kill me.” Rami (1226-1294 A.D.)
Effect of V1-Vasopressin Antagonist on Arterial Blood Pressure in Experimental Cirrhosis in Rats
ALDOSTERONE ANTAGONISM PROMOTES WEIGHT LOSS AND DISAPPEARANCE OF ASCITES IN DECOMPENSATED CIRRHOSIS PARAMETER Death Weight loss (lb) Disappearance of ascites CIRRHOTIC PATIENTS CONTROL (n-22) 7 6 + 2 4 SPIRONOLACTONE (n=21) 5 24 + 4 16 Gregory et al., 1977
Increased Distal Tubular Sodium Delivery with Mannitol Resulted in a Marked Natriuresis During ANP Infusion
Urinary cGMP Increased Significantly During ANP and ANP + Mannitol
Distal Sodium Delivery During Mannitol and ANP + Mannitol in Cirrhotic Patients
Mean Arterial Pressure is Increased by Immersion Plus Norepinephrine but not by Immersion Alone
Effect of Increased Arterial Circulatory Integrity to Normalize Renal Water Excretion in Decompensated Cirrhotic Patients
Correlation Between Increase in Systemic Vascular Resistance and an Increase in Water Excretion in Cirrhotic Patients
Effects of Terlipressin and Albumin on Renal Function in Hepatrorenal Syndrome
Effect of Chronic NOS Inhibition on Systemic Vascular Resistance in Cirrhotic Rats with Ascites
Effect of NOS Inhibition for 7 Days on eNOS Protein Expression in Aortas and Mesenteric Arteries in Cirrhotic Rats with Ascites
Effect of Chronic NO Synthesis Inhibition on Aortic cGMP in Cirrhotic Rats with Ascites
Effect of NOS Inhibition for 7 Days on Plasma Arginine Vasopressin and Atrial Natriuretic Peptide in Cirrhotic Rats with Ascites
Effect of NOS Inhibition for 7 Days on Water Excretion in Cirrhotic Rats with Ascites
Effect of NOS Inhibition for 7 Days on Plasma Renin Activity and Aldosterone in Cirrhotic Rats with Ascites
Sodium Excretion is Increased by Chronic L-Name Treatment in Cirrhotic Rats
Changes in Systemic Hemodynamics and Plasma Volume During Pregnancy
Chronic L-NAME Treatment in Day 14 Pregnant Rats Returns Cardiac Output and SVR to Nonpregnant Levels
Chronic L-NAME Treatment in Day 14 Pregnant Rats Returns GFR and RPF to Nonpregnant Levels
Effect of Vehicle and V2 Antagonist on Water Balance in Pregnant Rats
PATHOPHYSIOLOGY OF WATER METABOLISMIN EDEMATOUS DISORDERS CONGESTIVE CARDIAC FAILURE CIRRHOSIS PREGNANCY Nitric Oxide CARDIAC OUTPUT PERIPHERAL VASODILATION NON-OSMOTIC VASOPRESSIN RELEASE V2 RECEPTOR ANTAGONIST VASOPRESSIN V2 RECEPTOR AQUAPORIN-2 INCREASED WATER PERMEABILITY OF COLLECTING DUCT WATER RETENTION