Systemic and renal neurovascular reactivity was investigated in eight patients with cirrhosis and in eight control subjects with fatty liver during postural changes. In the supine position, mean renal blood flow averaged 1.51 and 2.97 ml per gm per min in patients and controls, respectively (p < 0.02). During tilting, renal blood flow changed significantly (p < 0.05) and equally in patients and controls (15" head-down tilt: 12 and 13% increase, respectively; 60" head-up tilt: 27 and 32% decrease, respectively). Mean arterial blood pressure was significantly lower in patients than controls (82 vs. 95 mm Hg, p < 0.05) but did not change during the tilt. Plasma norepinephrine (NE) concentration was significantly higher in another eight patients with cirrhosis than in eight healthy controls (mean: 0.45 vs. 0.21 ng per ml in recumbency, p < 0.02). Following 60" head-up tilt, the increase in NE was similar in both groups. In another 10 patients with cirrhosis in recumbency, the splanchnic arterial-hepatic venous extraction of NE averaged 0.43 (p < 0.01), and the hepatic clearance of NE averaged 315 ml per min which is of the same order as previously reported in healthy controls. The right kidney released NE into the systemic circulation. Renal venous plasma NE exceeded arterial concentration by 34% (p < 0.01). It is concluded that sympathetic nervous activity is enhanced in patients with cirrhosis, and that this hyperactivity may be responsible for renal vasoconstriction in these patients. However, systemic and renal neurovascular reactivity seems to be maintained even at an advanced stage of the disease.
Cirrhosis is associated with a spectrum of circulatory changes viz. an elevated plasma volume (1, 2), cardiac output (3, 4), heart rate (5, 6), and possibly muscle perfusion (6) whereas arterial blood pressure (1, 5) and renal blood flow (5, 7,8) are decreased. The mechanisms of changes in vascular resistance in cirrhosis are unknown.
The rise in heart rate during various autonomic reflex stimulation tests has been found significantly reduced in cirrhosis (9), and impaired vasoconstriction in skin and muscles during a vertical tilt has been demonstrated even in patients with compensated cirrhosis (10). It has been