Plasma
renin activity (PRA), and concentrations of
aldosterone (PAL) and
arginine vasopressin (AVP) in plasma were determined in 15 patients with
ascites due to
cirrhosis. The concentrations in
ascites were analyzed simultaneously. Six patients were studied during extracorporeal
ascites retransfusion. All but one patient with
ascites showed elevated PAL (642 +/- 255 pg ml-1) and PRA (43 +/- 26 ng ml-1 h-1); all had increased AVP (7.3 +/- 5.1 pg ml-1). A low
ascites to plasma ratio was found for
aldosterone (0.023 +/- 0.023), but not for AVP (0.71 +/- 0.82). Retransfusion resulted in a normalization of central venous pressure (CVP), urinary volume,
sodium/
potassium ratio in urine, PAL and PRA, but not of AVP, serum
sodium concentration and urinary
sodium excretion. PRA and PAL increased again after
cessation of treatment, while urinary output, CVP and
sodium/
potassium ratio in urine decreased. The results support the 'underfilling' concept, but give evidence that, in addition, other factors must be involved in the impaired natriuresis in cirrhotic patients. They further support the concept of volume expansion and increased renal perfusion as reason for the therapeutic efficacy of
ascites retransfusion. Previous
diuretic treatment seems not to be of importance for altered
hormone metabolism in
liver cirrhosis. Storage in a third compartment may be
a factor in the persistently elevated AVP levels.