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Correction to Moore et al., N Engl J Med 327(25):1774-1778 December 17, 1992.

Correspondence
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Volume 329:63 July 1, 1993 Number 1
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Plasma Endothelin and the Hepatorenal Syndrome

 

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by Moore, K.
To the Editor: Moore et al. (Dec. 17 issue)1 reported that plasma endothelin concentrations were elevated in patients with the hepatorenal syndrome, but they provided no data indicating that endothelin may cause the renal dysfunction. Was the glomerular filtration rate or renal blood flow measured in these patients, and if so, what was the correlation between the results and the plasma endothelin concentrations? I would also like to know the results of measurements of plasma endothelin and renal function in patients with the hepatorenal syndrome who received liver transplants. Longitudinal studies of plasma endothelin concentrations in patients with liver disease are needed to prove that endothelin can cause renal failure in patients with the hepatorenal syndrome.


Rajiv Agarwal, M.D.
University of Texas Southwestern Medical Center
Dallas, TX 75235

 
To the Editor: Moore and colleagues state in the legend to Figure 1, "The horizontal bars indicate median values." The median is defined as a value on either side of which lie half the observed values. This is not the case for the plasma endothelin-1 results in the patients with the hepatorenal syndrome (Figure 1A) or for the plasma endothelin-3 results in most of the groups (Figure 1B). The bars are more likely to indicate the mean values.


Wenzel Nurnberger, M.D.
Heinrich Heine University
4000 Dusseldorf, Germany

References

  1. Moore K, Wendon J, Frazer M, Karani J, Williams R, Badr K. Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome. N Engl J Med 1992;327:1774-1778. [Abstract]
 
Dr. Moore replies:

To the Editor: Dr. Agarwal is quite right to say that our results do not prove that endothelin is a cause of the renal dysfunction in patients with the hepatorenal syndrome. The results, however, are consistent with the hypothesis that increases in plasma endothelin-1 concentrations may contribute to the renal vasoconstriction and decrease in glomerular filtration rate that occur in patients with this syndrome. We did not measure the glomerular filtration rate or renal blood flow as part of the study, nor have we measured plasma endothelin-1 concentrations serially in patients with the hepatorenal syndrome who are undergoing liver transplantation.

Dr. Nurnberger is correct: the horizontal bars in Figure 1 indicate the mean values, not the median values.


Kevin Moore, M.R.C.P.
Hammersmith Hospital
London W12 0NN, United Kingdom


 

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