It is well known that liver and kidney diseases often occur simultaneously.1 This association has been characterized by the term "hepatorenal syndrome," a morbid entity whose true nature is still unknown and whose existence even is sometimes questioned. Most of the clinical and experimental investigators interested in the "hepatorenal syndrome" have been concerned with the possible mechanism by which various hepatic diseases may alter renal function.
The reverse possibility, that is, the effect of renal failure on liver function, has been little studied. In patients with liver disease, however, the occurrence of even mild renal decompensation is often accompanied by the appearance or aggravation of symptoms usually attributed to failure of certain of the liver's functions (mental confusion, flapping tremor, and other signs of precoma or coma). It seems germane, therefore, to consider briefly the mechanisms by which renal failure may aggravate the condition of patients suffering from preexisting