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Panminerva Medica 1998 December;40(4):294-8


lingua: Inglese

Plasma levels of arginine vasopressin in hepatorenal syndrome

Pasqualetti P., Casale R.*

From the Department of Internal Medicine and Public Health Faculty of Medicine and Surgery, University of L’Aquila and the Division of 1st Internal Medicine, “S. Salvatore” General Hospital of Coppito, ASL 04, L’Aquila, Italy


Back­ground. The eti­ol­o­gy of hep­at­or­en­al syn­drome is ­still incom­plete­ly under­stood, but the non-osmot­ic ­release of argi­nine vas­o­pres­sin (AVP) ­seems to ­have an impor­tant ­role in its path­o­gen­e­sis. The aim of the ­study was to inves­ti­gate the cir­cu­lat­ing plas­ma con­cen­tra­tions of AVP in ­patients ­with hep­a-t­or­en­al syn­drome, com­pared ­with ­healthy con­trols, in rela­tion ­with plas­ma osmo­lal­ity.
Meth­ods. ­Venous ­blood sam­ples ­were ­drawn in 20 ­healthy sub­jects and in 20 ­patients ­with HRS for the deter­mi­na­tion of the plas­ma lev­els of AVP by ­radio-immu­noas­say and of plas­ma osmo­lal­ity. The com­par­i­son ­between the two ­groups was car­ried out by the Stu­dent “t”-­test for ­unpaired ­data; the plas­ma AVP lev­els ­were cor­re­lat­ed ­with the val­ues of plas­ma osmo­lal­ity by lin­e­ar regres­sion anal­y­sis.
­Results. The ­patients pre­sent­ed sig­nif­i­cant­ly (p<0.001) high­er plas­ma AVP lev­els in ­respect to con­trols; on the con­trary, plas­ma osmo­lal­ity was sig­nif­i­cant­ly low­er in ­patients ­than in con­trols (p<0.005). Where­as a sig­nif­i­cant (r=0.83; p<0.001) rela­tion­ship was dem­on­strat­ed ­between plas­ma AVP and osmo­lal­ity in con­trols, no sig­nif­i­cant (r=0.23; p>0.05) cor­re­la­tion was ­found in ­patients.
Con­clu­sions. ­These ­results con­firm the exis­tence of an acti­va­tion in the ­release of AVP in hep­at­or­en­al syn­drome, due to the acti­va­tion of the sym­pa­thet­ic adren­al ­system and to hypo­na­trie­mia. The con­trac­tion of diu­re­sis in hep­at­or­en­al syn­drome, on the oth­er ­hand, is not due to a defi­cien­cy in plas­ma AVP. AVP ­release ­occurs ­despite low plas­ma osmo­lal­ity, ­which nor­mal­ly inhib­its its secre­tion. ­This ­great ­upset in func­tion­al organ­iza­tion, togeth­er ­with ­that of the atri­o­pep­tin-­renin-angio­ten­sin-aldos­te­rone ­system, ­could ­play an impor­tant ­role in pro­mot­ing and/or in the main­te­nance of the ­hydro-elec­tro­lyte imbal­ance ­that char­ac­teriz­es the syn­drome.

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