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Impaired Renal Acidification in Alcoholic Liver Disease

Impaired Renal Acidification in Alcoholic Liver Disease Abstract • The prevalence of impaired renal acidification in alcoholic liver disease and its relationship to clinical and biochemical features were evaluated during a one-year period in a 60-bed liver unit. No cases of overt renal tubular acidosis (RTA) were found; all of 12 patients with low serum bicarbonate values and normal anion gap proved to have chronic respiratory alkalosis. However, there was a 57% prevalence of incomplete distal RTA in 42 patients who were tested with an acid load. Subjects with RTA had higher serum bilirubin levels (5.3±6.1 v 2.1±2.7 mg/dL) and lower prothrombin times (45%±22% v 64%±20%). Urinary pH correlated directly with serum bilirubin levels (r=+.38) and inversely with prothrombin times (r=-.46). The frequency of ascites and encephalopathy did not differ notably between the two groups of patients. No pathogenetic relation was observed with avid sodium retention, decreased excretion of nonreabsorbable anions, and elevated urinary excretion of bile acids. Therefore, we conclude that impaired renal acidification in alcoholic liver disease may be a sign of liver cell failure since it is more frequently observed in patients with a greater degree of liver dysfunction. (Arch Intern Med 1984;144:941-944) References 1. Smith PM, Middleton JE, Williams R: Renal tubular acidosis and cirrhosis. Postgrad Med J 1967;43:439-442.Crossref 2. Oster JR, Hotchkiss JL, Carbon M, et al: A short duration renal acidification test using calcium chloride. Nephron 1975;14:281-292.Crossref 3. Mashige F, Imai K, Osuga T: A simple and sensitive assay of total serum bile acids. Clin Chim Acta 1976;70:79-86.Crossref 4. Desmoulins M, Hadchouel P, Touboul J-P, et al: Un cas de cirrhose avec acidose tubulaire. Ann Med Interne 1971;122:897-902. 5. Vesin P, Goueron J, Dervichian M, et al: Acidose tubulaire rénale et hépatopathies alcooliques. Arch Fr Mal App Dig 1976;65:209-214. 6. Golding PL, Mason AS: Renal tubular acidosis and autoimmune liver disease. Gut 1971;12:153-157.Crossref 7. Golding PL: Renal tubular acidosis in chronic liver disease. Postgrad Med J 1975;51:550-556.Crossref 8. Shear L, Bonkowsky HL, Gabuzda GJ: Renal tubular acidosis in cirrhosis: A determinant of susceptibility to recurrent hepatic precoma. N Engl J Med 1969;280:1-7.Crossref 9. Oster JR, Hotchkiss JL, Carbon M, et al: Abnormal renal acidification in alcoholic liver disease. J Lab Clin Med 1975;85:987-1000. 10. Charmes J-P, Nicot G, Valette J-P, et al: Acidose tubulaire rénale latente du cirrhotique. Nouv Presse Med 1976;5:1731-1734. 11. Caregaro L, Lauro S, Ricci G, et al: Distal renal tubular acidosis in hepatic cirrhosis: Clinical and pathogenetic study. Clin Nephrol 1981;15: 143-147. 12. Parés A, Rimola A, Bruguera M, et al: Renal tubular acidosis in primary biliary cirrhosis. Gastroenterology 1981;80:681-686. 13. Golding PL, Smith M, Williams R: Multisystem involvement in chronic liver disease: Studies on the incidence and pathogenesis. Am J Med 1973;55:772-782.Crossref 14. Tannen RL: The relationship between urine pH and acid excretion: The influence of urine flow rate. J Lab Clin Med 1969;74:757-769. 15. Perez GO, Oster JR, Vaamonde CA: The effect of sodium depletion on the renal response to short-duration NH4Cl acid loading. Proc Soc Exp Biol Med 1977;154:562-567.Crossref 16. Bank N, Schwartz WB: The influence of anion penetrating ability on urinary acidification and the excretion of titratable acid. J Clin Invest 1960;39:1516-1524.Crossref 17. Tannen RL: The effect of uncomplicated potassium depletion on urine acidification. J Clin Invest 1970;49:813-827.Crossref 18. Better OS, Goldschmid Z, Chaimowitz C, et al: Defect in urinary acidification in cirrhosis. Arch Intern Med 1972;13:77-83.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Impaired Renal Acidification in Alcoholic Liver Disease

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.00350170077015
Publisher site
See Article on Publisher Site

Abstract

Abstract • The prevalence of impaired renal acidification in alcoholic liver disease and its relationship to clinical and biochemical features were evaluated during a one-year period in a 60-bed liver unit. No cases of overt renal tubular acidosis (RTA) were found; all of 12 patients with low serum bicarbonate values and normal anion gap proved to have chronic respiratory alkalosis. However, there was a 57% prevalence of incomplete distal RTA in 42 patients who were tested with an acid load. Subjects with RTA had higher serum bilirubin levels (5.3±6.1 v 2.1±2.7 mg/dL) and lower prothrombin times (45%±22% v 64%±20%). Urinary pH correlated directly with serum bilirubin levels (r=+.38) and inversely with prothrombin times (r=-.46). The frequency of ascites and encephalopathy did not differ notably between the two groups of patients. No pathogenetic relation was observed with avid sodium retention, decreased excretion of nonreabsorbable anions, and elevated urinary excretion of bile acids. Therefore, we conclude that impaired renal acidification in alcoholic liver disease may be a sign of liver cell failure since it is more frequently observed in patients with a greater degree of liver dysfunction. (Arch Intern Med 1984;144:941-944) References 1. Smith PM, Middleton JE, Williams R: Renal tubular acidosis and cirrhosis. Postgrad Med J 1967;43:439-442.Crossref 2. Oster JR, Hotchkiss JL, Carbon M, et al: A short duration renal acidification test using calcium chloride. Nephron 1975;14:281-292.Crossref 3. Mashige F, Imai K, Osuga T: A simple and sensitive assay of total serum bile acids. Clin Chim Acta 1976;70:79-86.Crossref 4. Desmoulins M, Hadchouel P, Touboul J-P, et al: Un cas de cirrhose avec acidose tubulaire. Ann Med Interne 1971;122:897-902. 5. Vesin P, Goueron J, Dervichian M, et al: Acidose tubulaire rénale et hépatopathies alcooliques. Arch Fr Mal App Dig 1976;65:209-214. 6. Golding PL, Mason AS: Renal tubular acidosis and autoimmune liver disease. Gut 1971;12:153-157.Crossref 7. Golding PL: Renal tubular acidosis in chronic liver disease. Postgrad Med J 1975;51:550-556.Crossref 8. Shear L, Bonkowsky HL, Gabuzda GJ: Renal tubular acidosis in cirrhosis: A determinant of susceptibility to recurrent hepatic precoma. N Engl J Med 1969;280:1-7.Crossref 9. Oster JR, Hotchkiss JL, Carbon M, et al: Abnormal renal acidification in alcoholic liver disease. J Lab Clin Med 1975;85:987-1000. 10. Charmes J-P, Nicot G, Valette J-P, et al: Acidose tubulaire rénale latente du cirrhotique. Nouv Presse Med 1976;5:1731-1734. 11. Caregaro L, Lauro S, Ricci G, et al: Distal renal tubular acidosis in hepatic cirrhosis: Clinical and pathogenetic study. Clin Nephrol 1981;15: 143-147. 12. Parés A, Rimola A, Bruguera M, et al: Renal tubular acidosis in primary biliary cirrhosis. Gastroenterology 1981;80:681-686. 13. Golding PL, Smith M, Williams R: Multisystem involvement in chronic liver disease: Studies on the incidence and pathogenesis. Am J Med 1973;55:772-782.Crossref 14. Tannen RL: The relationship between urine pH and acid excretion: The influence of urine flow rate. J Lab Clin Med 1969;74:757-769. 15. Perez GO, Oster JR, Vaamonde CA: The effect of sodium depletion on the renal response to short-duration NH4Cl acid loading. Proc Soc Exp Biol Med 1977;154:562-567.Crossref 16. Bank N, Schwartz WB: The influence of anion penetrating ability on urinary acidification and the excretion of titratable acid. J Clin Invest 1960;39:1516-1524.Crossref 17. Tannen RL: The effect of uncomplicated potassium depletion on urine acidification. J Clin Invest 1970;49:813-827.Crossref 18. Better OS, Goldschmid Z, Chaimowitz C, et al: Defect in urinary acidification in cirrhosis. Arch Intern Med 1972;13:77-83.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1984

References