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JAMA. 1963;183(3):204. doi:10.1001/jama.1963.03700030080018.
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Laennec's cirrhosis complicated by renal failure is one of the conditions sometimes included in the term "hepatorenal syndrome." Papper1 reported that although significant hypotension is not requisite, it is a frequent finding when oliguria appears in the cirrhotic patient. This investigator noted also that the profound changes in renal function need not be associated with anatomical renal abnormalities. These observations and other recent reports suggest that impaired renal perfusion rather than damage to the renal parenchyma is the fundamental factor in the production of oliguria and nitrogen retention. The elevated urinary concentration is in accord with such a theory; urine of high specific gravity is usually present in spite of renal failure. Moreover, renal failure may appear in cirrhotic patients after minimal gastrointestinal bleeding or after abdominal peracentesis, possibly as a consequence of a decrease in effective blood volume. Some of these patients respond to pressor drugs with an


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