Twenty patients with
cirrhosis and
ascites but no
renal failure were given
piretanide, a new
loop diuretic, in order to investigate its efficacy and to relate the
diuretic response with the pretreatment plasma
aldosterone concentration. Eleven patients responded to
piretanide 12 mg/day (equivalent in potency to 80 mg
furosemide); there was no response in nine patients. Both groups were similar with regard to liver function, plasma
urea, serum
creatinine, plasma
electrolytes, urine volume, and urine
potassium concentration. The basal urinary
sodium excretion was significantly higher in those patients who responded (23.6 +/- 5.7 mmol/day vs. 4.3 +/- 1.42 mmol/day; P < 0.01) (M +/- SE). Plasma
renin activity (PRA) and plasma
aldosterone concentration (PAC) were normal or only slightly increased in patients who responded to
piretanide (PRA = 1.22 +/- 0.20 ng/ml/h; PAC = 12.25 +/- 2.20 ng/100 ml) and very high in patients who did not respond (PRA = 8.71 +/- 1.18 ng/ml/h; PAC = 84.6 +/- 16.2 ng/100 ml) (P < 0.001). Patients unresponsive to
piretanide 12 mg/day also failed to respond when the dose was increased to 24 mg/day. However, the addition of
spironolactone, 150 mg/day, to
piretanide was followed in these patients by a marked increase in diuresis and natriuresis. These results strongly suggest that the pre-treatment level of
aldosterone is an important factor influencing the response to
loop diuretics in patients with non-azotaemic
cirrhosis and
ascites.