RENAL FAILURE IN LAENNEC'S CIRRHOSIS. II. SIMULTANEOUS DETERMINATION OF CARDIAC OUTPUT AND RENAL HEMODYNAMICS*

Abstract

A number of observations in patients with Laennec's cirrhosis dying with renal failure-one of the conditions sometimes included in the term hepatorenal syndrome-suggest that the observed oliguria and nitrogen retention may be secondary to impaired renal perfusion rather than to any lesion of the renal parenchyma. First, renal failure may develop with great rapidity. In several instances, normal glomerular filtration rate (GFR) had been demonstrated months, weeks, and even days before the development of renal failure (1). Second, renal failure may occur in patients with cirrhosis after mild gastrointestinal bleeding, not severe enough to produce significant change in hematocrit, or after abdominal paracentesis, even when only five liters of fluid are removed (1-3). Minimal bleeding and paracente