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Alcohol’s Impact on Kidney Function

Cell s Function depends not only on receiving a continuous supply of nutrients and elimi-nating metabolic waste products butalso on the existence of stable physi-cal and chemical conditions in theextracellular fluid1bathing it. Amongthe most important substances con-tributing to these conditions are water,sodium, potassium, calcium, andphosphate. Loss or retention of anyone of these substances can influencethe body s handling of the others. Inaddition, hydrogen ion concentration( , acid-base balance) influencescell structure and permeability as wellas the rate of metabolic reactions.

Alcohol’s Impact on Kidney Function MURRAY EPSTEIN, M.D. ... an intake of excessive fluid in the form of beer. Hilden and Svendsen (1975) observed hyponatremia in five patients who drank at least 5 liters of beer per day (L/d) without any other nourishment. (For comparison, a per-

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Transcription of Alcohol’s Impact on Kidney Function

1 Cell s Function depends not only on receiving a continuous supply of nutrients and elimi-nating metabolic waste products butalso on the existence of stable physi-cal and chemical conditions in theextracellular fluid1bathing it. Amongthe most important substances con-tributing to these conditions are water,sodium, potassium, calcium, andphosphate. Loss or retention of anyone of these substances can influencethe body s handling of the others. Inaddition, hydrogen ion concentration( , acid-base balance) influencescell structure and permeability as wellas the rate of metabolic reactions.

2 Theamounts of these substances must beheld within very narrow limits, re-gardless of the large variations possi-ble in their intake or loss. The kidneysare the organs primarily responsiblefor regulating the amounts and con-centrations of these substances in theextracellular addition to their role in regulat-ing the body s fluid composition, thekidneys produce hormones that influ-ence a host of physiological processes,including blood pressure regulation,red blood cell production, and calciummetabolism. Besides producing hor-mones, the kidneys respond to theactions of regulatory hormones pro-duced in the brain, the parathyroidglands in the neck, and the adrenalglands located atop the of the kidneys importantand varied role in the body, impair-ment of their Function can result in arange of disorders, from mild varia-tions in fluid balance to acute kidneyfailure and death.

3 Alcohol, one of thenumerous factors that can compro-mise Kidney Function , can interferewith Kidney Function directly, throughacute or chronic consumption, orindirectly, as a consequence of liverdisease. This article first reviewsdirect effects of alcohol on kidneystructure, Function , and regulation,highlighting relevant effects associatedwith liver disease. Following thisdiscussion, the article takes a more in-depth look at several important indirecteffects of alcohol on the kidneys thatoccur once liver disease has ANDMICROSCOPICCHANGESOne way in which alcohol directlyaffects the kidneys is by altering theform and structure of this pair of or-gans, as demonstrated by variousanimal studies.

4 For example, in anearly study on dogs (Chaikoff et ), investigators observed severalstriking alterations after chronic alco-hol administration. The basementmembrane of the glomerulus (seesidebar figure) became abnormallythickened and was characterized bycell proliferation. Further changes84 ALCOHOLHEALTH& RESEARCHWORLDA1 For a definition of this and other technicalterms used in this article, see the glossary, 96, and the sidebar, pp. 91 , , is professor ofmedicine in the Nephrology Sectionat the University of Miami School ofMedicine, Miami, s Impact on Kidney FunctionMURRAYEPSTEIN, Both acute and chronic alcohol consumption can compromise Kidney Function ,particularly in conjunction with established liver disease.

5 Investigators have observedalcohol-related changes in the structure and Function of the kidneys and impairment intheir ability to regulate the volume and composition of fluid and electrolytes in thebody. Chronic alcoholic patients may experience low blood concentrations of keyelectrolytes as well as potentially severe alterations in the body s acid-base addition, alcohol can disrupt the hormonal control mechanisms that govern kidneyfunction. By promoting liver disease, chronic drinking has further detrimental effectson the kidneys, including impaired sodium and fluid handling and even acute kidneyfailure.

6 KEY WORDS: Kidney Function ; Kidney disorder; disorder of fluid or electrolyte or acid-base balance; alcoholic liver disorder; hormones; body fluid; blood circulation; bloodpressure; sodium; potassium; phosphates; magnesium; calcium; literature reviewincluded enlarged and altered cells inthe Kidney tubules. In another study,Van Thiel and colleagues (1977)compared Kidney structure and func-tion in alcohol-fed and control alcohol-fed group experiencedkidney swelling and significantlyreduced Kidney Function .

7 In addition,under microscopic examination, thekidneys of alcohol-fed rats were foundto have cells enlarged with increasedamounts of protein, fat, and water,compared with those of the , clinicians long havenoted significant Kidney enlargement( , nephromegaly) in direct propor-tion to liver enlargement amongchronic alcoholic2patients afflictedwith liver cirrhosis. Laube and col-leagues (1967) suggested that bothcellular enlargement and cell prolifer-ation contribute to such nephro-megaly. In alcoholic patients withcirrhosis, these investigators reporteda 33-percent increase in Kidney weight,whereas they observed no appreciablekidney enlargement in alcoholic pa-tients without cirrhosis compared withcontrol subjects (Laube et al.)

8 1967).BLOOD-FLOWCHANGESN ormally the rate of blood flow, orperfusion, ( , hemodynamics) throughthe kidneys is tightly controlled, sothat plasma can be filtered and sub-stances the body needs can be reab-sorbed under optimal circumstances(see sidebar). Established liver diseaseimpairs this important balancing act,however, by either greatly augmentingor reducing the rates of plasma flowand filtration through the have not yet fully ex-plained the mechanisms underlyingthis wide range of abnormalities,though, and have devoted little atten-tion to alcohol s effects on kidneyhemodynamics in people who do nothave liver few studies focusing on alco-hol s direct effects on perfusion inhuman kidneys suggest that regulatorymechanisms retain control over thiscomponent of Kidney Function despitealcohol consumption.

9 Even at highblood alcohol levels, only minor fluc-tuations were found in the rates ofplasma flow and filtration through thekidneys (Rubini et al. 1955).Additional studies are needed to con-firm these observations, of subsequent studies inanimal models seem to vary accordingto the species examined, the route anddose of alcohol administration, and thelength of time after administration forwhich the study groups were example, some studies impliedthat acute alcohol consumption doesnot significantly change Kidney hemo-dynamics or sodium excretion in dogs,but these studies did not extend be-yond 6 hours after alcohol contrast.

10 Earlier studies that exam-ined dogs for a longer period reportedthat a single dose of 3 grams of alco-hol per kilogram of body weight (g/kg)elevated plasma volume between 10and 26 hours following alcohol inges-tion (Nicholson and Taylor 1940).3 Another study with dogs (Beard etal. 1965) disclosed that the effects ofchronic alcohol consumption enduredeven longer. The investigators notedincreased plasma and extracellular fluidvolume 1 week after chronic alcoholingestion, and these volume expansionspersisted for the remaining 7 weeks ofthe study.


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