RESUMEN
Renal hemodynamic changes begin early in the course of liver disease. Hepatorenal syndrome [HRS] is defined as functional renal failure in advanced cirrhosis and ascites. The aim of this study was to measure and assess the role of plasma renin activity, circulating plasma angiotensin II and serum aldosterone in the pathogenesis of hepatorenal syndrome. Forty eight chronic liver disease patients were selected. They were divided into three groups, Group I: 15 patients, diagnosed as having HRS according to inclusion criteria. Group II: 20 patients diagnosed as having cirrhosis with ascites and without renal impairment. Group III: 13 patients with cirrhosis without ascites and renal impairment. Twenty apparently healthy subjects matching the age and gender of patients served as a control group. All patients subjected to complete history taking and clinical examination, abdominal ultrasonography, urine analysis, liver and kidney function tests, urine proteins an, Na, serum Na and K, as well as plasma renin activity, plasma angiotensin II and serum aldosterone levels were measured in all patient groups and controls. A highly significant increase [p<0.01] in plasma renin activity, serum aldosterone and plasma angiotensin II levels were detected in HRS syndrome patients [group I] compared to the other patient groups and controls. Also, a statistically significant increase [p<0.01] in the serum creatinine and urea levels were observed in the HRS patients compared to other groups, while creatinine clearance was significantly lower in group I more than other groups. In addition a positive correlation [p<0.05] was found between serum creatinine level and each of plasma renin activity and serum aldosterone level in the group of HRS. In contrast, an inverse correlation [p<0.05] between serum sodium and aldosterone levels was detected in HRS patients. From the above results, we conclude that, the renin-angiotensin-aldosterone system might have a considerable role in the pathogenesis of HRS. Thus, a routine measurement of plasma renin activity, plasma angiotensin II and serum aldosterone levels could be recommended for cirrhotic patients with ascites, to detect early changes in their levels, that might indicate of developing HRS and early controlling of this potentially fatal complication cirrhotic patients