Renal failure is a key prognostic determinant in patients with end-stage liver disease (1). Because the seminal studies of Epstein et al. (2), the renal dysfunction of cirrhosis has been thought to be mainly a functional disorder in which the kidneys are thought to remain histologically normal. In fact, the current hypothesis describing the basis of renal dysfunction of cirrhosis suggests that it occurs as a result of intense renal vasoconstriction because of the activation of neurohu-moral systems consequent upon a reduction in effective arterial blood volume (3). The paper by Trawale et al. (4) in the current issue of the journal questions this traditional hypothesis and adds to some previous data suggesting that a considerable number of cirrhotic patients with renal dysfunction may have a wide spectrum of renal pathology either associated with abnormal urina-lysis and/or a significantly elevated serum creatinine.
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