Plasma Renin Activity and Urinary Sodium Excretion as Prognostic Indicators in Nonazotemic Cirrhosis with Ascites

Abstract

Azotemia is an ominous prognostic sign in cirrhosis with ascites. To investigate whether other renal disturbances are also prognostically significant, we studied the renin-aldosterone system and sodium excretion (U_NaV) in 75 patients who had nonazotemic cirrhosis with ascites and related these to survival. On the basis of plasma renin activity patients were classified in two groups. Group I included 34 patients with normal renin activity (1.13 ± 0.69 ng/mL · h) and Group II, 41 patients with high renin activity (7.46 ± 3.86 ng/mL · h). The two groups differed significantly (p < 0.001) in plasma aldosterone, U_NaV, and wedged hepatic venous pressure but not in clinical features, liver function, glomerular filtration, and renal plasma flow. Patients of Group I lived significantly longer than those of Group II (the 50% survival rates were 28 months and 6 months, respectively). Survival curves obtained after grouping the patients according to U_NaV (higher and lower than 10 meq/d) were almost identical to those obtained according to renin activity. The study results indicate that plasma renin activity and U_NaV are of prognostic value in nonazotemic cirrhosis with ascites.