Characterization of Renal Prostaglandin E Responsiveness in Decompensated Cirrhosis: Implications for Renal Sodium Handling

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Abstract
Endogenous renal prostaglandin E (PGE) may constitute a determinant of renal hemodynamics and renal Na handling in patients with cirrhosis. The effects of augmenting endogenous prostaglandins on renal function were assessed. Water immersion to the neck was used since previous studies demonstrated that the redistribution of blood volume and concomitant central hypervolemia thus induced produces a prompt and marked augmentation of PGE excretion in normal man. Thirteen cirrhotic patients were studied twice while in balance on a daily 10 mmol of Na/100 mmol of K diet during control and during water immersion. Urinary PGE was determined hourly for 6 h. Cirrhotic patients manifested a wide continuum of responses characterized by either a sluggish or barely discernible natriuretic response (n = 5) or an appropriate natriuretic response (n = 8). Water immersion to the neck resulted in a highly significant increase in mean UPGEV [urinary PGE excretion] which was 3-fold that manifested by normal subjects studied under identical conditions. Cumulative Na excretion during immersion correlated with PGE excretion (P < 0.05). These findings, together with the results of studies utilizing prostaglandin synthase inhibitors, are consistent with the postulate that renal PGE may play a role in the alterations of renal function in decompensated cirrhosis.