Neurohumoral fluid regulation in chronic liver disease

Søren Møller, Jens Henrik Sahl Henriksen

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    Abstract

    Impaired homeostasis of the blood volume, with increased fluid and sodium retention, is a prevailing element in the deranged systemic and splanchnic haemodynamics in patients with liver disease. In this review, some basic elements of the circulatory changes that take place and of neurohumoral fluid regulation are outlined in order to provide an update of recent investigations on the neuroendocrine compensation of circulatory and volume dysfunction in chronic liver disease. The underlying pathophysiology is a systemic vasodilatation in which newly described potent vasoactive substances such as nitric oxide and vasodilating peptides seem to play an important role. The development of central hypovolaemia and activation of potent vasoconstricting systems such as the renin-angiotensin-aldosterone system and the sympathetic nervous system lead to a hyperdynamic circulation with increased heart rate and cardiac output. Moreover, patients exhibit an autonomic dys- and hyperfunction with vascular hyporeactivity to pressor stimuli. The circulatory dysfunction may be part of a multiorgan failure with disturbed haemodynamics of various vascular beds, including those of the splanchnic system, kidneys, brain and lungs. It is still an enigma why patients with chronic liver disease are at the same time overloaded and functional hypovolaemic with a hyperdynamic, hyporeactive circulation. Further research is needed to find the solution to this apparent haemodynamic conflict concerning the abnormal neurohumoral fluid regulation in chronic liver disease.
    Translated title of the contributionNeurohumoral fluid regulation in chronic liver disease.
    Original languageEnglish
    JournalScandinavian Journal of Clinical & Laboratory Investigation
    Volume58
    Issue number5
    Pages (from-to)361-372
    Number of pages12
    ISSN0036-5513
    Publication statusPublished - 1998

    Bibliographical note

    Keywords: Adrenomedullin; Body Fluids; Calcitonin Gene-Related Peptide; Hemodynamics; Homeostasis; Humans; Kidney; Liver Diseases; Nitric Oxide; Peptides; Vasodilator Agents

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