Acute effects of nitric oxide synthase inhibition on systemic, hepatic, and renal hemodynamics in patients with cirrhosis and ascites

Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research
Laurent SpahrAntoine Hadengue

Abstract

Nitric oxide synthase (NOS) inhibition has been demonstrated to correct systemic vasodilation and renal hypoperfusion in studies of patients with cirrhosis. In patients with decompensated cirrhosis, NOS blockade increases arterial pressure, but the acute effects on hepatic and renal hemodynamics are not known. We examined the acute systemic, hepatic, and renal hemodynamic effects of N(G)-monomethyl-L-arginine (L-NMMA) in 10 patients with decompensated cirrhosis. After baseline measurements, 3 mg/kg L-NMMA was administered as an IV bolus. At 20 minutes, if mean arterial pressure did not increase by at least 10 mm Hg above the baseline value, a second injection of 6 mg/kg was administered. In 5 of 10 patients, the second injection of L-NMMA 6mg/kg was necessary to achieve at least a 10 mm Hg increase in mean arterial pressure. Acute NOS inhibition increased systemic vascular resistance and decreased cardiac output, without causing changes in the hepatic venous pressure gradient. Hepatic blood flow decreased, but the indocyanine green intrinsic clearance and extraction remained unchanged. Plasma renin activity (from 9.5 +/- 2.9 to 6.7 +/- 1.6 ng/ml/h) and urinary prostaglandin E2 (from 299 +/- 40 to 112 +/- 36 pg/ml) significantly...Continue Reading

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Citations

Feb 20, 2007·Digestive Diseases and Sciences·Andrés CárdenasNezam H Afdhal
May 8, 2003·Current Gastroenterology Reports·Mahmoud SabriJohn M Peters
Feb 20, 2009·Journal of Gastroenterology and Hepatology·Zeid KayaliWarren N Schmidt
Jul 3, 2013·Liver International : Official Journal of the International Association for the Study of the Liver·Jesper N BechErling B Pedersen
Nov 5, 2016·Disease-a-month : DM·Natasha ShahEdgar Lerma
Jul 23, 2003·The American Journal of Gastroenterology·Andres Cardenas
Jan 7, 2003·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Vijay Shah, Patrick S Kamath
Feb 27, 2018·Journal of the American Heart Association·Jessica R WilsonJessica K Devin
Mar 23, 2005·Liver International : Official Journal of the International Association for the Study of the Liver·Paolo AngeliWladimiro Jiménez
Aug 19, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Hani M WadeiThomas A Gonwa
Sep 25, 2017·Journal of Clinical and Translational Hepatology·Gautam Ray
Aug 16, 2005·Journal of Pineal Research·Adolfo CruzJordi Muntané
Feb 11, 2005·Current Opinion in Gastroenterology·Guadalupe Garcia-Tsao

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