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Effekte einer Captopriltherapie auf die Natrium- und Wasserausscheidung bei Patienten mit Leberzirrhose und Aszites

Effects of a captopril-therapy on sodium- and water-excretion in patients with liver cirrhosis and ascites

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Summary

Ascites in patients with cirrhosis of the liver frequently is refractory to diuretic treatment. It was postulated that vasoconstriction of the renal cortex, mediated by activation of the renin-angiotensin-aldosterone-system (RAAS), may be one course of the disturbed sodium- and water-excretion in these patients. We therefore investigated in 14 cirrhotic patients with ascites under constant diuretic treatment the effects of low-dose captopril therapy on urinary sodium- and potassium-excretion, body weight, abdominal girth, serum-sodium,-potassium, creatinine-clearance, plasma-renin-activity (PRA), plasma-aldosterone (PA) and mean arterial pressure (MAP). After a control period of 4 days the patients received 2 × 6.25 mg/d captopril for 5 days and 4 × 6.25 mg/d for further 5 days. Treatment was followed by a second control period without captopril.

PRA increased significantly after 2 days of captopril treatment. 2 × 6.25 mg/d captopril induced a significant increase in sodium excretion and a significant decrease of body weight. MAP decreased slightly but significantly without clinical signs of hypotension. 4 × 6.25 mg/d captopril resulted in a further reduction of body weight and a further enhancement of sodium excretion. Three days after withdrawal of captopril sodium output was significantly reduced again. Conclusion: In cirrhotic patients low-dose captopril seems to be efficient in the treatment of ascites resistant to diuretics without causing major side effects.

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Abbreviations

ACE:

Angiotensin-Converting-Enzym

A-II:

Angiotensin II

CH 2 O :

Frei-Wasser-Clearance

CKrea :

Kreatinin-Clearance

COsmo :

Osmolale Clearance

g:

Gramm

h:

Stunde

kg:

Kilogramm

l/d:

Liter pro Tag

MAP:

Mittlerer arterieller Blutdruck

mg:

Milligramm

mg/d:

Milligramm pro Tag

ml/min:

Milliliter pro Minute

mmHg:

Millimeter Quecksilbersäule (Torr)

mmol/d:

Millimol pro Tag

NaCl:

Natriumchlorid

ng/ml/h:

Nanogramm pro Milliliter und Stunde

PA:

Plasma-Aldosteron

pg/ml:

Picogramm pro Milliliter

PRA:

Plasma-Renin-Aktivität

RAAS:

Renin-Angiotensin-Aldosteron-System

SEM:

Standardfehler des Mittelwertes

SKrea :

Kreatininkonzentration im Serum

SOsm :

Serum-Osmolalität

UKrea :

Kreatininkonzentration im Urin

UOsm :

Urin-Osmolalität

V:

Urinminutenvolumen

vgl.:

vergleiche

µmol/l:

Micromol pro Liter

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Authors and Affiliations

  1. Abteilung Nephrologie Zentrums Innere Medizin der Medizinischen Hochschule Hannover, Germany

    R. Brunkhorst, E. Wrenger & K. Koch

  2. Gastroenterologie des Zentrums Innere Medizin der Medizinischen Hochschule Hannover, Germany

    F. W. Schmidt

  3. Medizinische Klinik im Klinikum Karlsruhe, Germany

    K. Kühn

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  1. R. Brunkhorst
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  2. E. Wrenger
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  5. K. Koch
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Brunkhorst, R., Wrenger, E., Kühn, K. et al. Effekte einer Captopriltherapie auf die Natrium- und Wasserausscheidung bei Patienten mit Leberzirrhose und Aszites. Klin Wochenschr 67, 774–783 (1989). https://doi.org/10.1007/BF01745350

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