Ascites and hepatorenal syndrome: Pathophysiology and management

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32 Citations (Scopus)

Abstract

Ascites, a late manifestation of cirrhosis of the liver, causes increased morbidity and mortality. The renin-angiotensin-aldosterone system, the sympathetic nervous system, and arginine vasopressin are responsible for sodium and water retention in patients with cirrhosis. Fluid localizes to the peritoneal cavity mainly as a result of portal hypertension. Recent developments in the understanding of the pathophysiologic mechanisms of ascites include the role of inadequate renal prostaglandin production in the development of the hepatorenal syndrome and the possible role of nitric oxide in the pathogenesis of the renal complications of cirrhosis. The aim of medical therapy is to achieve a negative sodium balance and, consequently, fluid loss. Large-volume paracentesis is safe and effective in the management of tense ascites, but use of diuretic agents should be continued to prevent reaccumulation of ascites. Liver transplantation, transjugular intrahepatic portosystemic shunts, or LeVeen shunts should be considered in selected patients with persistent ascites. In patients with diuretic-resistant or diuretic-refractory ascites, a thorough assessment must be performed to exclude potentially reversible causes. The hepatorenal syndrome has an associated grave prognosis, especially in patients who are not candidates for liver transplantation.

Original languageEnglish (US)
Pages (from-to)874-881
Number of pages8
JournalMayo Clinic Proceedings
Volume71
Issue number9
StatePublished - 1996

Fingerprint

Hepatorenal Syndrome
Ascites
Diuretics
Liver Transplantation
Fibrosis
Peritoneovenous Shunt
Sodium
Transjugular Intrahepatic Portasystemic Shunt
Paracentesis
Kidney
Water-Electrolyte Balance
Arginine Vasopressin
Sympathetic Nervous System
Peritoneal Cavity
Portal Hypertension
Renin-Angiotensin System
Liver Cirrhosis
Prostaglandins
Nitric Oxide
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ascites and hepatorenal syndrome : Pathophysiology and management. / Roberts, Lewis Rowland; Kamath, Patrick Sequeira.

In: Mayo Clinic Proceedings, Vol. 71, No. 9, 1996, p. 874-881.

Research output: Contribution to journalArticle

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