[Renal, hemodynamic and hormonal effects of repeated water immersion in liver cirrhosis]

In patients with cirrhosis of the liver sodium retention plays an important role in fluid and salt disturbances. We performed a study in 3 groups of 12 compensated and 7 decompensated cirrhotic patients and 11 controls to determine the renal, hemodynamic and hormonal effect of repeated water immersion (6 immersions in 3 weeks). In all groups immersion resulted in a marked acute natriuresis and diuresis combined with acute reduction of blood pressure. In both cirrhotic groups we found decreased salt excretion except the acute effect of immersion in comparison with controls. The natriuresis of the immersion day were in decompensated patients significantly elevated in comparison with a control day. This was not due to the acute, but the prolonged immersion effect on renal excretion. During the study the immersion effects increased in both groups of cirrhotic subjects. The controls showed decreased responses. The immersion response shall be caused at least, in part by the Atrial Natriuretic Peptide (ANP): all groups had a significant elevation of ANP during the immersion which was like the renal natriuresis prolonged in the 6th immersion in cirrhotics. A repeated water immersion may improve the natriuretic responsiveness of cirrhotics, especially those of decompensated patients.