Original Articles

The American Journal of Digestive Diseases

, Volume 21, Issue 3, pp 249-256

First online:

Prognostic value of spontaneous hyponatremia in cirrhosis with ascites

  • Vicente ArroyoAffiliated withLiver Unit and Renal Department, Hospital Clínico, University of Barcelona
  • , Juan RodésAffiliated withLiver Unit and Renal Department, Hospital Clínico, University of Barcelona
  • , Miguel A. Gutiérrez-LizárragaAffiliated withLiver Unit and Renal Department, Hospital Clínico, University of Barcelona
  • , Luís RevertAffiliated withLiver Unit and Renal Department, Hospital Clínico, University of Barcelona

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Abstract

Spontaneous hyponatremia in cirrhosis with ascites is generally considered to be due to an impaired renal ability to excrete free water, to be a contraindication of diuretics, and to be a bad prognostic sign. These concepts are reviewed in this paper. 55 cirrhotics with ascites were divided into three groups. Group I consisted of 13 patients with hyponatremia and very low free-water clearance (\(C_{H_2 O} \), 0.07±0.26 ml/min). These patients also had poor renal function: low inulin clearance (C INU , 40.6±25.9 ml/min) and paraamino-hippurate clearance (C PAH , 383±275 ml/min). Group II consisted of 8 patients who also had hyponatremia.\(C_{H_2 O} \), C INU , and C PAH in these patients were fairly high: 5.85±1.53 ml/min, 85.7±26.2 ml/min, and 651±294 ml/min. These values are similar to those of the 34 patients without hyponatremia who make up Group III: (6.37±4.27 ml/min, 94.7±33.1 ml/min, and 598±199 ml/min). Hyponatremia in Group I could be related to the impaired free-water clearance. The mechanism of hyponatremia in Group II patients is not clear. Patients with hyponatremia and low C INU and C PAH had a negative response to diuretics and a poor prognosis. Patients with hyponatremia but with relatively good renal function had a good prognosis, similar to Group III patients. They responded to diuretics with no worsening of their hyponatremia.