Hyporeninemic hypoaldosteronism in a patient with cirrhosis and ascites

A patient with cirrhosis and coexistent hyporeninemic hypoaldosteronism secondary to diabetic nephropathy rapidly formed ascites despite marked reductions in plasma aldosterone concentration and urinary aldosterone excretion. To my knowledge, this association has not been previously reported. This case supports the concept that hyperaldosteronism is not a necessary component of the salt retention of advanced liver disease. Furthermore, it suggests that certain renal disorders should be considered in cases of cirrhosis and ascites with decreased plasma renin activity.