The Kidney in Cirrhosis

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Abstract
The clinical and biochemical features in 25 patients with cirrhosis in whom azotemia developed without evidence of primary renal disease or any external precipitating factor are described. Azotemia developed in the presence of severe impairment of hepatic function and ascites, especially when the ascites became relatively resistant to therapy, and was associated with progressive hyponatremia. Nonspecific clinical changes, increasing hyponatremia, hyperkalemia, normal or minimally elevated blood creatinine concentrations, and rarely, anemia were found. Oliguria and arterial hypotension were late features rather than precipitating factors of the syndrome, and none of several external factors could be incriminated as important precipitating mechanisms. Prognosis was grave, but not hopeless, and recovery was most clearly related to improvement in hepatic function.