The precise relation between hepatic disease and disturbed renal function is not known, although the two are observed concurrently in acute hepatitis and even more often in the diverse forms of cirrhosis. Speculation on the mechanisms involved includes suggestion of either disturbances of renal hemodynamics or of water and sodium transport. Glomerular filtration may remain normal or even above normal in decompensated liver disease; however, the inability to eliminate "free water" is a rather constant accompaniment of advanced hepatic disease. Moreover, renal failure may unexpectedly supervene in the patient with severe hepatic disease and lead to clinical worsening or death.
The anatomic alterations in renal functional disturbances remained practically unknown until a few years ago when, in addition to minor tubular changes, glomerular abnormalities were noted in patients with cirrhosis. It was proposed that these abnormalities, encompassed under the name "cirrhotic glomerulosclerosis," were directly related to the hepatic diseases.1
THE KIDNEY IN HEPATIC DISEASE. JAMA. 1965;192(13):1156–1157. doi:10.1001/jama.1965.03080260044014
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