Endogenous dopaminergic activity in Child-Pugh A cirrhosis: potential role in renal sodium handling and in the maintenance of clinical compensation.

Background We studied the main determinants of aldosterone secretion in a group of 20 patients with biopsy-proven Child-Pugh A cirrhosis without previous ascites or diuretic consumption. Methods We evaluated the plasma levels of adrenocorticotrophic hormone (ACTH), active renin and aldosterone (both supine at 07.00 h and after 30 min of upright posture),and active renin and aldosterone responses 30 thin and 60 min after the administration of metoclopramide, a dopamine DA(2) antagonist (10 mg e.v.). Nine normal subjects were also submitted to the metoclopramide stimulation test. Results Compared with control subjects, the patients showed significantly greater incremental aldosterone responses both 30 min and 60 min after metoclopramide (+30 min: 157.5 +/- 73.3 vs. 83.5 +/- 32.2 pg mL(-1), P < 0.003; +60 min: 142.1 +/- 87.2 vs. 36.8 +/- 39.0 pg mL(-1), P < 0.001). We found significant positive correlations between amplitude of aldosterone response 30 min after metoclopramide and 24-h urinary fractional excretion of sodium (r = 0.61, P < 0.01) and basal morning aldosterone levels (r = 0.69, P < 0.001). Conclusions The higher incremental aldosterone responses observed after metoclopramide in cirrhotic patients are expressions of increased dopaminergic activity in these patients compared with control subjects. Moreover, the correlation we found between the degree of dopaminergic activity and 24-h urinary fractional excretion of sodium suggests a role for endogenous dopamine as a relevant mediator of natriuresis in cirrhosis, at least in patients with compensated disease.