Treatment and management of ascites and hepatorenal syndrome: an update
Ascites and renal dysfunction are frequent complications experienced by patients with cirrhosis of the liver. Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and is one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves assessment of...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2015-03-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/1756283X14564673 |
| _version_ | 1818554486869721088 |
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| author | Kurt Lenz Robert Buder Lisbeth Kapun Martin Voglmayr |
| author_facet | Kurt Lenz Robert Buder Lisbeth Kapun Martin Voglmayr |
| author_sort | Kurt Lenz |
| collection | DOAJ |
| description | Ascites and renal dysfunction are frequent complications experienced by patients with cirrhosis of the liver. Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and is one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves assessment of its granulocyte count and protein concentration to exclude complications such as infection or malignoma and to allow risk stratification for the development of spontaneous peritonitis. Although sodium restriction and diuretics remain the cornerstone of the management of ascites, many patients require additional therapy when they become refractory to this treatment. In this situation, the treatment of choice is repeated large-volume paracentesis. Alteration in splanchnic hemodynamics is one of the most important changes underlying the development of ascites. Further splanchnic dilation leads to changes in systemic hemodynamics, activating vasopressor agents and leading to decreased renal perfusion. Small alterations in renal function influence the prognosis, which depends on the cause of renal failure. Prerenal failure is evident in about 70% of patients, whereas in about 30% of patients the cause is hepatorenal syndrome (HRS), which is associated with a worse prognosis. Therefore, effective therapy is of great clinical importance. Recent data indicate that use of the new definition of acute kidney injury facilitates the identification and treatment of patients with renal insufficiency more rapidly than use of the current criteria for HRS. In this review article, we evaluate approaches to the management of patients with ascites and HRS. |
| first_indexed | 2024-12-12T09:40:19Z |
| format | Article |
| id | doaj.art-2e62db0f1de6489c9c881b8bf9c9b46f |
| institution | Directory Open Access Journal |
| issn | 1756-283X 1756-2848 |
| language | English |
| last_indexed | 2024-12-12T09:40:19Z |
| publishDate | 2015-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-2e62db0f1de6489c9c881b8bf9c9b46f2022-12-22T00:28:34ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-283X1756-28482015-03-01810.1177/1756283X14564673Treatment and management of ascites and hepatorenal syndrome: an updateKurt LenzRobert BuderLisbeth KapunMartin VoglmayrAscites and renal dysfunction are frequent complications experienced by patients with cirrhosis of the liver. Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and is one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves assessment of its granulocyte count and protein concentration to exclude complications such as infection or malignoma and to allow risk stratification for the development of spontaneous peritonitis. Although sodium restriction and diuretics remain the cornerstone of the management of ascites, many patients require additional therapy when they become refractory to this treatment. In this situation, the treatment of choice is repeated large-volume paracentesis. Alteration in splanchnic hemodynamics is one of the most important changes underlying the development of ascites. Further splanchnic dilation leads to changes in systemic hemodynamics, activating vasopressor agents and leading to decreased renal perfusion. Small alterations in renal function influence the prognosis, which depends on the cause of renal failure. Prerenal failure is evident in about 70% of patients, whereas in about 30% of patients the cause is hepatorenal syndrome (HRS), which is associated with a worse prognosis. Therefore, effective therapy is of great clinical importance. Recent data indicate that use of the new definition of acute kidney injury facilitates the identification and treatment of patients with renal insufficiency more rapidly than use of the current criteria for HRS. In this review article, we evaluate approaches to the management of patients with ascites and HRS.https://doi.org/10.1177/1756283X14564673 |
| spellingShingle | Kurt Lenz Robert Buder Lisbeth Kapun Martin Voglmayr Treatment and management of ascites and hepatorenal syndrome: an update Therapeutic Advances in Gastroenterology |
| title | Treatment and management of ascites and hepatorenal syndrome: an update |
| title_full | Treatment and management of ascites and hepatorenal syndrome: an update |
| title_fullStr | Treatment and management of ascites and hepatorenal syndrome: an update |
| title_full_unstemmed | Treatment and management of ascites and hepatorenal syndrome: an update |
| title_short | Treatment and management of ascites and hepatorenal syndrome: an update |
| title_sort | treatment and management of ascites and hepatorenal syndrome an update |
| url | https://doi.org/10.1177/1756283X14564673 |
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