SOLOMON PAPPER, M.D.; CARLOS A. VAAMONDE, M.D.
Many investigators have demonstrated the occurrence of spontaneous, unexplained renal failure in patients with cirrhosis (1, 2). Patients with this syndrome are usually, but not necessarily, severely oliguric and almost invariably die, although death generally cannot be attributed directly to renal failure. At autopsy the kidneys seldom exhibit lesions of proved functional significance and may be entirely normal.
The following evidence has strongly indicated a circulatory mechanism in this syndrome:  Renal failure may develop rapidly—in months, weeks, or days;  the syndrome is often accompanied by a modest reduction in blood pressure;  the urine may be concentrated early,
PAPPER S, VAAMONDE CA. Renal Failure in Cirrhosis—Role of Plasma Volume. Ann Intern Med. ;68:958–959. doi: 10.7326/0003-4819-68-4-958
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Published: Ann Intern Med. 1968;68(4):958-959.
Gastroenterology/Hepatology, Liver Disease, Nephrology.
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