This review summarizes the current knowledge on the multiple effects of alcohol overconsumption on renal function and on water, electrolyte, and acid-base homeostasis. In contrast to the known transient diuretic effects, the overall long-term effect of chronic alcohol overconsumption is water and salt retention with expansion of extracellular volume.
In addition, depletion of magnesium, phosphate, and calcium is also frequently noted in alcohol-dependent patients. These electrolyte disturbances may be associated with alcohol-induced hypoparathyroidism and parathyroid hormone resistance in skeletal muscle, as well as decreases in serum osteocalcin.
Metabolic acidosis with lower arterial blood pH and lower plasma bicarbonate concentrations has been noted in alcoholic patients on admission, and a significant correlation between chronic alcohol overconsumption and increased incidence of hyperuricemia and gout attacks has also been reported.
Alcohol appears to have a dual effect on blood pressure. Increased blood pressure has been demonstrated in men over 80 g and in women over 40 g of ethanol consumption daily. In contrast, young adults who consumed only 10 to 20 g per day had lower blood pressure than the abstinent group, indicating a J-curve relationship. This is consistent with the reduced risk of coronary heart disease associated with regular consumption of small amounts of alcohol.
The mechanisms responsible for the association between excessive alcohol consumption and postinfectious glomerulonephritis have not yet been elucidated. Finally, severe alcohol abuse predisposes to acute renal failure and appears to be related to the general catabolic effects.
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