Résumé
The aim of this work has been to study the relationship between plasma levels of angiotensin II [ATII] and serum levels of angiotensin-converting enzyme [ACE] and parameters of renal function in different stages of liver cirrhosis and to examine the effects of Losartan, an A TU-receptor antagonist on these parameters in a selected group of patients. The cross-sectional basic study included 59 patients with posthepatitis C liver cirrhosis and 19 healthy controls. Patients were classified into 4 groups: A: compensated cirrhosis [n=l6]; B: portal hypertension [n=11]; C: ascites [n=21]; and D: hepatorenal syndrome [HRS; n=11]. They underwent clinical, sonographic and endoscopic examinations. Biochemical tests included liver and kidney function tests, serum and urinary electrolytes, serum level of ACE and plasma level of ATII. Eleven patients of group B and 8 from group C, who were not hypotensive or of Child grade C, were given a daily oral dose of 25 mg losartan for 14 days. Clinical and biochemical evaluations were performed before and after treatment. Systemic levels of ACE and ATII were significantly elevated in all patients than in controls with no overlap of values. Their levels increased progressively from group A to group C and correlated significantly with Child-Pugh score, manifestations of portal hypertension [portal vein diameter and grade of varices] and kidney function tests. The most significant correlation was a negative one between ATII levels and creatinine clearance which appeared the most sensitive kidney function test as it was reduced in many patients with normal urea and creatinine values. Results of the present study indicate that plasma level of ATII is a very sensitive index that can predict the occurrence of functional renal abnormalities in cirrhotic patients even in well compensated cases. Patients treated with Losartan showed mild decrease in the mean arterial blood pressure which was significant in the ascitic cases only. Liver function tests showed no significant change and there was no clinical deterioration. Blood urea and serum creatinine, sodium and potassium showed no significant change after treatment. Urinary sodium and creatinine clearance increased significantly in both portal hypertensive and ascitic cases. Levels of ACE and ATII were elevated in both groups. This indicates a beneficial effect of losartan that should be evaluated in long-term studies including larger number of patients