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Update on ascites and hepatorenal syndrome
P Gentilini1, F Vizzutti, A Gentilini
1Department of Internal Medicine, School of Medicine, University of Florence, Florence Italy. p.gentilini@dmi.unifi.it
Summary
Ascites in liver cirrhosis causes kidney problems and fluid buildup. Treatments for refractory ascites include paracentesis with albumin or shunts to manage kidney failure.
Area of Science:
- Hepatology
- Nephrology
- Gastroenterology
Background:
- Ascites is a common complication of liver cirrhosis.
- Renal impairment and hepatorenal syndrome occur in patients with tense, refractory ascites.
- Pathogenesis involves sodium and water retention, plasma volume expansion, and altered vascular resistance.
Purpose of the Study:
- To explore the pathogenesis of ascites in liver cirrhosis.
- To understand the mechanisms leading to refractory ascites.
- To review treatment approaches for refractory ascites and associated renal impairment.
Main Methods:
- Review of experimental and clinical data on ascites pathogenesis.
- Analysis of mechanisms of sodium and water retention.
- Discussion of neurohormonal and autacoid system activation.
Main Results:
- Ascites formation is linked to increased intrahepatic pressure and abnormal fluid handling.
- Peripheral arterial vasodilation and decreased effective arterial volume activate compensatory systems.
- In advanced cirrhosis, renal impairment worsens as autacoid systems become exhausted, leading to diuretic resistance.
Conclusions:
- Refractory ascites is a complex condition with multifactorial pathogenesis.
- Treatment strategies aim to manage fluid overload and prevent renal failure.
- Therapeutic options include paracentesis with albumin, vasoactive drugs, shunts, and liver transplantation.