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Alcohol's Impact on Kidney Function

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Alcohol's Impact on Kidney Function Alcohol’s Impact on Kidney Function MURRAY EPSTEIN, M.D. Both acute and chronic alcohol consumption can compromise kidney function, particularly in conjunction with established liver disease. Investigators have observed alcohol-related changes in the structure and function of the kidneys and impairment in their ability to regulate the volume and composition of fluid and electrolytes in the body. Chronic alcoholic patients may experience low blood concentrations of key electrolytes as well as potentially severe alterations in the body’s acid-base balance. In addition, alcohol can disrupt the hormonal control mechanisms that govern kidney function. By promoting liver disease, chronic drinking has further detrimental effects on the kidneys, including impaired sodium and fluid handling and even acute kidney failure. KEY WORDS: kidney function; kidney disorder; disorder of fluid or electrolyte or acid-base balance; alcoholic liver disorder; hormones; body fluid; blood circulation; blood pressure; sodium; potassium; phosphates; magnesium; calcium; literature review cell’s function depends not only centrations of these substances in the indirectly, as a consequence of liver on receiving a continuous extracellular fluid. disease. This article first reviews A supply of nutrients and elimi- In addition to their role in regulat- direct effects of alcohol on kidney nating metabolic waste products but ing the body’s fluid composition, the structure, function, and regulation, also on the existence of stable physi- kidneys produce hormones that influ- highlighting relevant effects associated cal and chemical conditions in the ence a host of physiological processes, with liver disease. Following this extracellular fluid1 bathing it. Among including blood pressure regulation, discussion, the article takes a more in- the most important substances con- red blood cell production, and calcium depth look at several important indirect tributing to these conditions are water, metabolism. Besides producing hor- effects of alcohol on the kidneys that sodium, potassium, calcium, and mones, the kidneys respond to the occur once liver disease has become phosphate. Loss or retention of any actions of regulatory hormones pro- established. one of these substances can influence duced in the brain, the parathyroid the body’s handling of the others. In glands in the neck, and the adrenal addition, hydrogen ion concentration GROSS AND MICROSCOPIC glands located atop the kidneys. CHANGES (i.e., acid-base balance) influences Because of the kidneys’ important cell structure and permeability as well and varied role in the body, impair- One way in which alcohol directly as the rate of metabolic reactions. The ment of their function can result in a affects the kidneys is by altering the amounts of these substances must be range of disorders, from mild varia- form and structure of this pair of or- held within very narrow limits, re- tions in fluid balance to acute kidney gans, as demonstrated by various gardless of the large variations possi- animal studies. For example, in an ble in their intake or loss. The kidneys failure and death. Alcohol, one of the numerous factors that can compro- early study on dogs (Chaikoff et al. are the organs primarily responsible 1948), investigators observed several for regulating the amounts and con- mise kidney function, can interfere with kidney function directly, through striking alterations after chronic alco- acute or chronic consumption, or hol administration. The basement MURRAY EPSTEIN, M.D., is professor of membrane of the glomerulus (see sidebar figure) became abnormally medicine in the Nephrology Section 1For a definition of this and other technical at the University of Miami School of terms used in this article, see the glossary, pp. thickened and was characterized by Medicine, Miami, Florida. 93–96, and the sidebar, pp. 91–92. cell proliferation. Further changes 84 ALCOHOL HEALTH & RESEARCH WORLD Alcohol’s Impact on Kidney Function included enlarged and altered cells in The few studies focusing on alco- volume (i.e., its diuretic effect) alters the kidney tubules. In another study, hol’s direct effects on perfusion in the body’s fluid level (i.e., hydration Van Thiel and colleagues (1977) human kidneys suggest that regulatory state) and produces disturbances in compared kidney structure and func- mechanisms retain control over this electrolyte concentrations. These tion in alcohol-fed and control rats. component of kidney function despite effects vary depending on factors such The alcohol-fed group experienced alcohol consumption. Even at high as the amount and duration of drink- kidney swelling and significantly blood alcohol levels, only minor fluc- ing, the presence of other diseases, reduced kidney function; in addition, tuations were found in the rates of and the drinker’s nutritional status under microscopic examination, the plasma flow and filtration through the (see table, p. 90). kidneys of alcohol-fed rats were found kidneys (Rubini et al. 1955). to have cells enlarged with increased Additional studies are needed to con- Fluid amounts of protein, fat, and water, firm these observations, however. compared with those of the control Results of subsequent studies in Alcohol can produce urine flow with- animals. animal models seem to vary according in 20 minutes of consumption; as a Similarly, clinicians long have to the species examined, the route and result of urinary fluid losses, the con- noted significant kidney enlargement dose of alcohol administration, and the centration of electrolytes in blood (i.e., nephromegaly) in direct propor- length of time after administration for serum increases. These changes can tion to liver enlargement among which the study groups were observed. be profound in chronic alcoholic pa- chronic alcoholic2 patients afflicted For example, some studies implied tients, who may demonstrate clinical with liver cirrhosis. Laube and col- that acute alcohol consumption does evidence of dehydration. leagues (1967) suggested that both not significantly change kidney hemo- As most investigators now agree, cellular enlargement and cell prolifer- dynamics or sodium excretion in dogs, increased urine flow results from alco- ation contribute to such nephro- but these studies did not extend be- hol’s acute inhibition of the release of megaly. In alcoholic patients with yond 6 hours after alcohol ingestion. antidiuretic hormone (ADH), a hor- cirrhosis, these investigators reported In contrast, earlier studies that exam- mone also known as vasopressin, a 33-percent increase in kidney weight, ined dogs for a longer period reported which normally promotes the forma- whereas they observed no appreciable that a single dose of 3 grams of alco- tion of concentrated urine by inducing kidney enlargement in alcoholic pa- hol per kilogram of body weight (g/kg) the kidneys to conserve fluids. In the tients without cirrhosis compared with elevated plasma volume between 10 absence of ADH, segments of the control subjects (Laube et al. 1967). and 26 hours following alcohol inges- kidney’s tubule system become imper- tion (Nicholson and Taylor 1940).3 meable to water, thus preventing it from being reabsorbed into the body. BLOOD-FLOW CHANGES Another study with dogs (Beard et al. 1965) disclosed that the effects of Under these conditions, the urine Normally the rate of blood flow, or chronic alcohol consumption endured formed is dilute and electrolyte con- perfusion, (i.e., hemodynamics) through even longer. The investigators noted centration in the blood simultaneously the kidneys is tightly controlled, so increased plasma and extracellular fluid rises. Although increased serum elec- that plasma can be filtered and sub- volume 1 week after chronic alcohol trolyte concentration normally acti- stances the body needs can be reab- ingestion, and these volume expansions vates secretion of ADH so that fluid sorbed under optimal circumstances persisted for the remaining 7 weeks of balance can be restored, a rising blood (see sidebar). Established liver disease the study. Similar alterations have been alcohol level disrupts this regulatory impairs this important balancing act, found in body fluid volumes among response by suppressing ADH secre- however, by either greatly augmenting chronic alcoholic patients. tion into the blood. or reducing the rates of plasma flow Interestingly, age makes a difference and filtration through the glomerulus. in how rapidly the body escapes alco- Investigators have not yet fully ex- EFFECTS ON FLUID AND hol’s ADH-suppressive effect. People plained the mechanisms underlying ELECTROLYTE BALANCE older than age 50 overcome suppres- this wide range of abnormalities, One of the main functions of the kid- sion of ADH more quickly than their though, and have devoted little atten- neys is to regulate both the volume and younger counterparts do, despite reach- tion to alcohol’s effects on kidney the composition of body fluid, includ- ing similar serum electrolyte concentra- hemodynamics in people who do not ing electrically charged particles (i.e., tions after alcohol consumption. In have liver disease. ions), such as sodium, potassium, and older people, ADH levels sharply in- chloride ions (i.e., electrolytes). How- crease following alcohol intake, per- 2The terms “alcoholic patient” and “alcoholism” haps in part because sensitivity to as used in this article are summary terms for ever, alcohol’s ability to increase urine the diagnoses of alcohol abuse and alcohol increased electrolyte concentration
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