Increased plasma nitric oxide, L-arginine, and arginase-1 in cirrhotic patients with progressive renal dysfunction

Zeid Kayali, Jason Herring, Pedro Baron, Edson Franco, Okechukwu Ojogho, Jason Smith, Gregory Watkins, Douglas Smith, Victor Lamin, Thanh Hoang, Rajiv Sharma, Meleah Mathahs, Lawrance Sowers, Kyle E. Brown, Warren N. Schmidt

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background and Aims: Increased levels of nitric oxide (NO) are hypothesized to contribute to renal dysfunction in patients with decompensated cirrhosis. In this study, we examined whether splanchnic and/or peripheral NO levels and L-arginine (L-Arg) correlate with progressive renal dysfunction in cirrhotics. Methods: Serum NO metabolites (NOx) and L-Arg were measured in: controls (n = 10); organ donors (n = 12); compensated cirrhotics (n = 17), cirrhotics with ascites (n = 25), refractory ascites (n = 11) or hepatorenal syndrome type II (HRS) (n = 11) and chronic renal failure patients (n = 18). Results: Plasma NOx and L-Arg levels rose progressively with worsening renal function in decompensated cirrhotics. Both NOx and L-Arg levels were highest in patients with HRS (P < 0.001 and P < 0.025, respectively). While there were no differences in NOx levels related to the site of sampling, L-Arg levels were lowest in hepatic venous blood. There were significant relationships of NOx and L-Arg with Model for End-Stage Liver Disease score and Child-Pugh scores (P < 0.04 and P < 0.01, respectively). Multivariate analysis showed a significant relationship between NOx, L-Arg and HRS. Conclusion: Worsening renal function in decompensated cirrhosis is accompanied by progressive elevation in plasma NOx and L-Arg. These findings support the hypothesis that NO-mediated vasodilation is probably linked with the mechanism of progressive renal failure in decompensated cirrhotics.

Original languageEnglish (US)
Pages (from-to)1030-1037
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number6
StatePublished - Jun 2009
Externally publishedYes


  • Ascites
  • Cirrhosis
  • Hepatorenal syndrome
  • L-Arginine
  • Nitric oxide
  • Refractory ascites
  • Renal failure

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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