Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome

Background. Severe renal vasoconstriction is central to the pathogenesis of renal failure in the hepatorenal syndrome. Endothelin-1 and endothelin-3 are potent, long-acting vasoconstrictors, and endothelin-1 has selective potency as a renal vasoconstrictor. These properties suggest a role for endothelins in the hepatorenal syndrome. Methods. We measured plasma endothelin-1 and endothelin-3 concentrations using specific radioimmunoassays in subjects with the hepatorenal syndrome, liver disease but normal renal function, chronic renal failure, acute renal failure, liver dysfunction and renal impairment, or normal liver and kidney function. Results. The patients with the hepatorenal syndrome had markedly elevated mean (±SE) plasma concentrations of endothelin-1 (36±5 ng per liter [14.5± 1.8 pmol per liter]) and endothelin-3 (43±3 ng per liter [16.3±1.0 pmol per liter]) as compared with the normal subjects (endothelin-1, 4±1 ng per liter [1.7±0.2 pmol per liter]; and endothelin-3, 18±1 ng per liter [6.8±0.4 pmol per liter]; P