Hepatology International

, Volume 2, Issue 4, pp 416–428 | Cite as

Pathogenetic background for treatment of ascites and hepatorenal syndrome

  • Søren Møller
  • Jens H. Henriksen
  • Flemming Bendtsen
Review Article

Abstract

Ascites and hepatorenal syndrome (HRS) are the major and challenging complications of cirrhosis and portal hypertension that significantly affect the course of the disease. Liver insufficiency, portal hypertension, arterial vasodilatation, and systemic cardiovascular dysfunction are major pathophysiological hallmarks. Modern treatment of ascites is based on this recognition and includes modest salt restriction and stepwise diuretic therapy with spironolactone and loop diuretics. Tense and refractory ascites should be treated with a large volume paracentesis, followed by volume expansion or transjugular intrahepatic portosystemic shunt. New treatment strategies include the use of vasopressin V2-receptor antagonists and vasoconstrictors. The HRS denotes a functional and reversible impairment of renal function in patients with severe cirrhosis with a poor prognosis. Attempts of treatment should seek to improve liver function, ameliorate arterial hypotension and central hypovolemia, and reduce renal vasoconstriction. Ample treatment of ascites and HRS is important to improve the quality of life and prevent further complications, but since treatment of fluid retention does not significantly improve survival, these patients should always be considered for liver transplantation.

Keywords

Hepatic decompensation Portal hypertension Hyperdynamic circulation 

Abbreviations

ET-1

Endothelin-1

GFR

Glomerular filtration rate

HRS

Hepatorenal syndrome

RAAS

Renin–angiotensin–aldosterone system

RBF

Renal blood flow

SBP

Spontaneous bacterial peritonitis

SNS

Sympathetic nervous system

TIPS

Transjugular intrahepatic portosystemic shunt

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Copyright information

© Asian Pacific Association for the Study of the Liver 2008

Authors and Affiliations

  • Søren Møller
    • 1
  • Jens H. Henriksen
    • 1
  • Flemming Bendtsen
    • 2
  1. 1.Department of Clinical Physiology 239, Hvidovre Hospital, Faculty of Health SciencesUniversity of CopenhagenHvidovreDenmark
  2. 2.Department of Medical Gastroenterology 439, Hvidovre Hospital, Faculty of Health SciencesUniversity of CopenhagenHvidovreDenmark

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