Skip to main content
SpringerLink
Log in

Pathogenetic background for treatment of ascites and hepatorenal syndrome

  • Review Article
  • Published:
Hepatology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

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

References

  1. Gines P, Cardenas A, Arroyo V, Rodes J. Management of cirrhosis and ascites. N Engl J Med 2004;350(16):1646–1654

    Article  PubMed  CAS  Google Scholar 

  2. Henriksen JH, Møller S. Alterations of hepatic and splanchnic microvascular exchange in cirrhosis: local factors in the formation of ascites. In Gines P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and Renal Dysfunction in Liver Disease. Malden: Blackwell; 2005. 174–185

    Chapter  Google Scholar 

  3. Arroyo V, Colmenero J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J Hepatol 2003;38(Suppl 1):S69–S89

    Article  PubMed  Google Scholar 

  4. Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P, Uriz J, Quinto L, Ventura PJ, et al. A prognostic model for predicting survival in cirrhosis with ascites. J Hepatol 2001;34(1):46–52

    Article  PubMed  CAS  Google Scholar 

  5. Guevara M, Cardenas A, Ginés P. Prognosis of patients with cirrhosis and ascites. In Ginés P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and Renal Dysfunction in Liver Disease. Malden: Blackwell; 2005. 260–270

    Chapter  Google Scholar 

  6. Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology 2005;41(3):422–433

    Article  PubMed  CAS  Google Scholar 

  7. Arroyo V, Terra C, Gines P. Advances in the pathogenesis and treatment of type-1 and type-2 hepatorenal syndrome. J Hepatol 2007;46(5):935–946

    Article  PubMed  CAS  Google Scholar 

  8. Dagher L, Moore K. The hepatorenal syndrome. Gut 2001;49(5):729–737

    Article  PubMed  CAS  Google Scholar 

  9. Gentilini P, Vizzutti F, Gentilini A, Zipoli M, Foschi M, Romanelli RG. Update on ascites and hepatorenal syndrome. Dig Liver Dis 2002;34(8):592–605

    Article  PubMed  CAS  Google Scholar 

  10. Bernardi M, Caraceni P. Pathogenesis of ascites and hepatorenal syndrome: altered haemodynamics and neurohumoral systems. In Gerbes AL, Beuers U, Jungst D, Pape G, Sackmann M, Sauerbruch T, editors. Hepatology 2000. Falk Symposium 117, Munich, May 6, 2000. Dordrecht: Kluwer Academic Publishers; 2001. 185–203

    Google Scholar 

  11. Schrier RW. Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol 2007;18(7):2028–2031

    Article  PubMed  Google Scholar 

  12. Kravetz D, Bildozola M, Argonz J, Romero G, Korula J, Munoz A, et al. Patients with ascites have higher variceal pressure and wall tension than patients without ascites. Am J Gastroenterol 2000;95(7):1770–1775

    Article  PubMed  CAS  Google Scholar 

  13. Bosch J, Abraldes JG, Groszmann R. Current management of portal hypertension. J Hepatol 2003;38:S54–S68

    Article  PubMed  Google Scholar 

  14. Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 2006;43(2 Suppl 1):S121–S131

    Article  PubMed  CAS  Google Scholar 

  15. Møller S, Henriksen JH. The systemic circulation in cirrhosis. In Gines P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and Renal Dysfunction in Liver Disease. Malden: Blackwell; 2005. 139–155

    Google Scholar 

  16. Henriksen JH, Siemssen O, Krintel JJ, Malchow-Møller A, Bendtsen F, Ring-Larsen H. Dynamics of albumin in plasma and ascitic fluid in patients with cirrhosis. J Hepatol 2001;34(1):53–60

    Article  PubMed  CAS  Google Scholar 

  17. Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006;55(Suppl 6):vi1–vi12

    Article  PubMed  Google Scholar 

  18. Casado M, Bosch J, Garciapagan JC, Bru C, Banares R, Bandi JC, et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998;114(6):1296–1303

    Article  PubMed  CAS  Google Scholar 

  19. Liu H, Schuelert N, McDougall JJ, Lee SS. Central neural activation of hyperdynamic circulation in portal hypertensive rats depends on vagal afferent nerves. Gut 2008;57:966–973

    Article  PubMed  CAS  Google Scholar 

  20. Wiest R. Splanchnic and systemic vasodilation: the experimental models. J Clin Gastroenterol 2007;41(10 Suppl 3):S272–S287

    PubMed  Google Scholar 

  21. Ruiz-Del-Arbol L, Monescillo A, Arocena C, Valer P, Gines P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology 2005;42:439–447

    Article  PubMed  CAS  Google Scholar 

  22. Ferguson JW, Dover A, Chia S, Cruden N, Hayes PC, Newby D. Inducible nitric oxide synthase activity contributes to the regulation of peripheral vascular tone in patients with cirrhosis and ascites. Gut 2005;55(4):542–546

    Article  PubMed  CAS  Google Scholar 

  23. Iwakiri Y, Groszmann RJ. Vascular endothelial dysfunction in cirrhosis. J Hepatol 2007;46:927–934

    Article  PubMed  CAS  Google Scholar 

  24. Wiest R, Groszmann RJ. The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology 2002;35(2):478–491

    Article  PubMed  CAS  Google Scholar 

  25. Henriksen JH, Møller S. Hemodynamics, distribution of blood volume, and kinetics of vasoactive substances in cirrhosis. In Epstein M, editor. The Kidney in Liver Disease. Philadelphia: Hanley & Belfus; 1996. 241–258

    Google Scholar 

  26. Farzaneh-Far R, Moore K. Nitric oxide and the liver. Liver 2001;21(3):161–174

    Article  PubMed  CAS  Google Scholar 

  27. Helmy A, Newby DE, Jalan R, Johnston NR, Hayes PC, Webb DJ. Nitric oxide mediates the reduced vasoconstrictor response to angiotensin II in patients with preascitic cirrhosis. J Hepatol 2003;38(1):44–50

    Article  PubMed  CAS  Google Scholar 

  28. Møller S, Henriksen JH. Cardiovascular complications of cirrhosis. Gut 2008;57(2):268–278

    Article  PubMed  CAS  Google Scholar 

  29. Henriksen JH, Møller S, Schifter S, Abrahamsen J, Becker U. High arterial compliance in cirrhosis is related to elevated circulating calcitonin gene-related peptide (CGRP) and low adrenaline, but not to activated vasoconstrictor systems. Gut 2001;49:112–118

    Article  PubMed  CAS  Google Scholar 

  30. Levy M. Pathogenesis of sodium retention in early cirrhosis of the liver: evidence for vascular overfilling. Semin Liver Dis 1994;14:4–13

    Article  PubMed  CAS  Google Scholar 

  31. La Villa G, Salmeron JM, Arroyo V, Bosch J, Gines P, Garcia-Pagan JC, et al. Mineralocorticoid escape in patients with compensated cirrhosis and portal hypertension. Gastroenterology 1992;102:2114–2119

    PubMed  Google Scholar 

  32. Bernardi M, Li BS, Arienti V, de Collibus C, Scialpi C, Boriani L, et al. Systemic and regional hemodynamics in pre-ascitic cirrhosis: effects of posture. J Hepatol 2003;39(4):502–508

    Article  PubMed  Google Scholar 

  33. Wensing G, Lotterer E, Link I, Hahn EG, Fleig WE. Urinary sodium balance in patients with cirrhosis: relationship to quantitative parameters of liver function. Hepatology 1997;26:1149–1155

    PubMed  CAS  Google Scholar 

  34. Møller S, Henriksen JH. Pathogenesis and pathophysiology of hepatorenal syndrome—is there scope for prevention? Aliment Pharmacol Ther 2004;20(Suppl 3):31–41

    Article  PubMed  Google Scholar 

  35. Angeli P, Wong F, Watson H, Gines P. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology 2006;44(6):1535–1542

    Article  PubMed  CAS  Google Scholar 

  36. Bernardi M, Matco CD, Trevisani F, Collibus CD, Fornalé L, Baraldini M, et al. The hemodynamic status of preascitic cirrhosis: an evaluation under steady-state conditions and after postural change. Hepatology 1992;16:341–346

    Article  PubMed  CAS  Google Scholar 

  37. Sansoe G, Ferrari A, Baraldi E, Castellana CN, De Santis MC, Manenti F. Renal distal tubular handling of sodium in central fluid volume homoeostasis in preascitic cirrhosis. Gut 1999;45(5):750–755

    Article  PubMed  CAS  Google Scholar 

  38. Claria J, Rodes J. Renal sodium handling in preascitic cirrhosis. Gut 2001;48(5):740–741

    Article  PubMed  CAS  Google Scholar 

  39. Pozzi M, Grassi G, Redaelli E, Dell’Oro R, Ratti L, Redaelli A, et al. Patterns of regional sympathetic nerve traffic in preascitic and ascitic cirrhosis. Hepatology 2001;34(6):1113–1118

    Article  PubMed  CAS  Google Scholar 

  40. Bernardi M, Domenicali M. The renin-angiotensin-aldosterone system in cirrhosis. In Ginés P, Arroyo V, Rodes J, Schrier RW, editors. Ascites and Renal Dysfunction in Liver Disease. Malden: Blackwell; 2005. p. 43–54

    Google Scholar 

  41. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet 2003;362(9398):1819–1827

    Article  PubMed  CAS  Google Scholar 

  42. Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis 2008;28(1):81–95

    Article  PubMed  Google Scholar 

  43. Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996;23:164–176

    Article  PubMed  CAS  Google Scholar 

  44. Ring-Larsen H. Renal blood flow in cirrhosis: relation to systemic and portal haemodynamics and liver function. Scand J Clin Lab Invest 1977;37:635–642

    Article  PubMed  CAS  Google Scholar 

  45. La Villa G, Barletta G, Pantaleo P, Del Bene R, Vizzutti F, Vecchiarino S, et al. Hemodynamic, renal, and endocrine effects of acute inhibition of nitric oxide synthase in compensated cirrhosis. Hepatology 2001;34(1):19–27

    Article  PubMed  Google Scholar 

  46. Epstein M. Renal sodium handling in liver disease. In Epstein M, editor. The Kidney in Liver Disease. Philadelphia: Hanley & Belfus; 1996. 1–31

    Google Scholar 

  47. Gerbes AL, Gulberg V, Waggershauser T, Holl J, Reiser M. Renal effects of transjugular intrahepatic portosystemic shunt in cirrhosis: comparison of patients with ascites, with refractory ascites, or without ascites. Hepatology 1998;28(3):683–688

    Article  PubMed  CAS  Google Scholar 

  48. Moreau R, Asselah T, Condat B, de Kerguenec C, Pessione F, Bernard B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut 2002;50(1):90–94

    Article  PubMed  CAS  Google Scholar 

  49. Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, del Arbol LR, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002;123(6):1839–1847

    Article  PubMed  Google Scholar 

  50. Laffi G, La Villa G, Gentilini P. Pathogenesis and management of the hepatorenal syndrome. Semin Liver Dis 1994;14(1):71–81

    Article  PubMed  CAS  Google Scholar 

  51. Arroyo V, Guevara M, Gines P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2002;122(6):1658–1676

    Article  PubMed  Google Scholar 

  52. Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transpl 2006;21(2):478–482

    Article  Google Scholar 

  53. Jalan R, Forrest EH, Redhead DN, Dillon JF, Hayes PC. Reduction in renal blood flow following acute increase in the portal pressure: evidence for the existence of a hepatorenal reflex in man? Gut 1997;40:664–670

    PubMed  CAS  Google Scholar 

  54. Kapoor D, Redhead DN, Hayes PC, Webb DJ, Jalan R. Systemic and regional changes in plasma endothelin following transient increase in portal pressure. Liver Transpl 2003;9(1):32–39

    Article  PubMed  Google Scholar 

  55. Møller S, Henriksen JH. Neurohumoral fluid regulation in chronic liver disease. Scand J Clin Lab Invest 1998;58(5):361–372

    Article  PubMed  Google Scholar 

  56. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J. Peripheral artery vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988;5:1151–1157

    Article  Google Scholar 

  57. Henriksen JH, Ring-Larsen H. Hepatorenal disorders: role of the sympathetic nervous system. Semin Liver Dis 1994;14:35–43

    Article  PubMed  CAS  Google Scholar 

  58. Henriksen JH. Cirrhosis: ascites and hepatorenal syndrome. Recent advances in pathogenesis. J Hepatol 1995;23:25–30

    PubMed  Google Scholar 

  59. Wong F, Moore K, Dingemanse J, Jalan R. Lack of renal improvement with nonselective endothelin antagonism with tezosentan in type 2 hepatorenal syndrome. Hepatology 2008;47(1):160–168

    Article  PubMed  CAS  Google Scholar 

  60. Stadlbauer VP, Wright GA, Banaji M, Mukhopadhya A, Mookerjee R, Moore K, et al. Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis. Gastroenterology 2008;134(1):111–119

    Article  PubMed  Google Scholar 

  61. Dagher L, Patch D, Marley R, Moore K, Burroughs A. Review article: pharmacological treatment of the hepatorenal syndrome in cirrhotic patients. Aliment Pharmacol Ther 2000;14(5):515–521

    Article  PubMed  CAS  Google Scholar 

  62. Llach J, Ginés P, Arroyo V, Rimola A, Titó L, Badalamenti S, et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology 1988;94:482–487

    PubMed  CAS  Google Scholar 

  63. Ruiz-Del-Arbol L, Urman J, Fernandez J, Gonzalez M, Navasa M, Monescillo A, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 2003;38(5):1210–1218

    Article  PubMed  Google Scholar 

  64. Alqahtani SA, Fouad TR, Lee SS. Cirrhotic cardiomyopathy. Semin Liver Dis 2008;28(1):59–69

    Article  PubMed  CAS  Google Scholar 

  65. Krag A, Bendtsen F, Henriksen JH, Møller S. Low cardiac index predicts survival and renal failure in patients with ascites. Evidence of a heart-kidney axis in cirrhosis. J Hepatol 2008;48:S118

    Article  Google Scholar 

  66. Wong F, Blei AT, Blendis LM, Thuluvath PJ. A vasopressin receptor antagonist (VPA-985) improves serum sodium concentration in patients with hyponatremia: a multicenter, randomized, placebo-controlled trial. Hepatology 2003;37(1):182–191

    Article  PubMed  CAS  Google Scholar 

  67. Gerbes AL, Gulberg V, Gines P, Decaux G, Gross P, Gandjini H, et al. Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial. Gastroenterology 2003;124(4):933–939

    Article  PubMed  CAS  Google Scholar 

  68. Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis 2008;28(1):26–42

    Article  PubMed  CAS  Google Scholar 

  69. Salerno F, Restelli B, Incerti P, Annoni G, Capozza L, Badalamenti S, et al. Utility of ascitic fluid analysis in patients with malignancy-related ascites. Scand J Gastroenterol 1990;25(3):251–256

    PubMed  CAS  Google Scholar 

  70. Ring-Larsen H, Henriksen JH, Wilken C, Clausen J, Pals H, Christensen NJ. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture. BMJ 1986;292:1351–1353

    PubMed  CAS  Google Scholar 

  71. Gines P, Cardenas A. The management of ascites and hyponatremia in cirrhosis. Semin Liver Dis 2008;28(1):43–58

    Article  PubMed  CAS  Google Scholar 

  72. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003;38(1):258–266

    Article  PubMed  Google Scholar 

  73. Fernandez-Esparrach G, Guevara M, Sort P, Pardo A, Jimenez W, Gines P, et al. Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo. J Hepatol 1997;26(3):614–620

    Article  PubMed  CAS  Google Scholar 

  74. Salerno F, Badalamenti S, Lorenzano E, Moser P, Incerti P. Randomized comparative study of hemaccel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology 1991;13(4):707–713

    PubMed  CAS  Google Scholar 

  75. Fassio E, Terg R, Landeira G, Abecasis R, Salemne M, Podesta A, et al. Paracentesis with dextran 70 vs. paracentesis with albumin in cirrhosis with tense ascites. Results of a randomized study. J Hepatol 1992;14(2–3):310–316

    Article  PubMed  CAS  Google Scholar 

  76. Altman C, Bernard B, Roulot D, Vitte RL, Ink O. Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis. Eur J Gastroenterol Hepatol 1998;10(1):5–10

    Article  PubMed  CAS  Google Scholar 

  77. Planas R, Gines P, Arroyo V, Llach J, Panes J, Vargas V, et al. Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis. Gastroenterology 1990;99:1736–1744

    PubMed  CAS  Google Scholar 

  78. Cabrera J, Falcon L, Gorriz E, Pardo MD, Granados R, Quinones A, et al. Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites. Gut 2001;48(3):384–389

    Article  PubMed  CAS  Google Scholar 

  79. Pozzi M, Ratti L, Redaelli E, Guidi C, Mancia G. Cardiovascular abnormalities in special conditions of advanced cirrhosis. The circulatory adaptative changes to specific therapeutic procedures for the management of refractory ascites. Gastroenterol Hepatol 2006;29:263–272

    Article  PubMed  CAS  Google Scholar 

  80. Gines P, Guevara M, De Las HD, Arroyo V. Review article: albumin for circulatory support in patients with cirrhosis. Aliment Pharmacol Ther 2002;16(Suppl 5):24–31

    Article  PubMed  CAS  Google Scholar 

  81. Sola-Vera J, Minana J, Ricart E, Planella M, Gonzalez B, Torras X, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 2003;37(5):1147–1153

    Article  PubMed  CAS  Google Scholar 

  82. Gines A, Fernandez-Esparrach G, Monescillo A, Vila C, Domenech E, Abecasis R, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002–1010

    Article  PubMed  CAS  Google Scholar 

  83. Moreau R, Valla DC, Durand-Zaleski I, Bronowicki JP, Durand F, Chaput JC, et al. Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail. Liver Int 2006;26(1):46–54

    Article  PubMed  CAS  Google Scholar 

  84. Singh V, Kumar B, Nain CK, Singh B, Sharma N, Bhalla A, et al. Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study. J Intern Med 2006;260(1):62–68

    Article  PubMed  CAS  Google Scholar 

  85. Krag A, Møller S, Henriksen JH, Holstein-Rathlou NH, Larsen FS, Bendtsen F. Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome. Hepatology 2007;46(6):1863–1871

    Article  PubMed  CAS  Google Scholar 

  86. Singh V, Dheerendra PC, Singh B, Nain CK, Chawla D, Sharma N, et al. Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol 2008;103(6):1399–1405

    Article  PubMed  CAS  Google Scholar 

  87. D’Amico G, Luca A, Morabito A, Miraglia R, D’Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology 2005;129(4):1282–1293

    Article  PubMed  Google Scholar 

  88. Rossle M, Ochs A, Gulberg V, Siegerstetter V, Holl J, Deibert P, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000;342(23):1701–1707

    Article  PubMed  CAS  Google Scholar 

  89. Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007;133(3):825–834

    Article  PubMed  CAS  Google Scholar 

  90. Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006;(4):CD004889

  91. Esteva-Font C, Baccaro ME, Fernandez-Llama P, Sans L, Guevara M, Ars E, et al. Aquaporin-1 and aquaporin-2 urinary excretion in cirrhosis: relationship with ascites and hepatorenal syndrome. Hepatology 2006;44(6):1555–1563

    Article  PubMed  CAS  Google Scholar 

  92. Gines P. Vaptans: a promising therapy in the management of advanced cirrhosis. J Hepatol 2007;46(6):1150–1152

    Article  PubMed  CAS  Google Scholar 

  93. Gerbes AL, Gulberg V. Progress in treatment of massive ascites and hepatorenal syndrome. World J Gastroenterol 2006;12(4):516–519

    PubMed  Google Scholar 

  94. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of the hepatorenal syndrome in cirrhosis. A consensus workshop of the International Ascites Club. Gut 2007;56:1310–1318

    Article  PubMed  CAS  Google Scholar 

  95. Angeli P, Merkel C. Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis. J Hepatol 2008;48(Suppl 1):S93–S103

    Article  PubMed  CAS  Google Scholar 

  96. Navasa M, Feu F, Garciapagan JC, Jimenez W, Llach J, Rimola A, et al. Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis. Hepatology 1993;17:355–360

    PubMed  CAS  Google Scholar 

  97. Bahirwani R, Campbell MS, Siropaides T, Markmann J, Olthoff K, Shaked A, et al. Transplantation: impact of pretransplant renal insufficiency. Liver Transpl 2008;14(5):665–671

    Article  PubMed  Google Scholar 

  98. Guevara M, Gines P, Bandi JC, Gilabert R, Sort P, Jimenez W, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology 1998;28(2):416–422

    Article  PubMed  CAS  Google Scholar 

  99. Hadengue A, Gadano A, Moreau R, Giostra E, Durand F, Valla D, et al. Beneficial effects of the 2-day administration of terlipressin in patients with cirrhosis and hepatorenal syndrome. J Hepatol 1998;29(4):565–570

    Article  PubMed  CAS  Google Scholar 

  100. Uriz J, Gines P, Cardenas A, Sort P, Jimenez W, Salmeron JM, et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol 2000;33(1):43–48

    Article  PubMed  CAS  Google Scholar 

  101. Møller S, Hansen EF, Becker U, Brinch K, Henriksen JH, Bendtsen F. Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients. Liver 2000;20(1):51–59

    Article  PubMed  Google Scholar 

  102. Mulkay JP, Louis H, Donckier V, Bourgeois N, Adler M, Deviere J, et al. Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome: a pilot study. Acta Gastroenterol Belg 2001;64(1):15–19

    PubMed  CAS  Google Scholar 

  103. Ortega R, Gines P, Uriz J, Cardenas A, Calahorra B, De Las HD, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 2002;36(4 Pt 1):941–948

    PubMed  CAS  Google Scholar 

  104. Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichai P, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology 2002;122(4):923–930

    Article  PubMed  CAS  Google Scholar 

  105. Guevara M, Gines P, Fernandezesparrach G, Sort P, Salmeron JM, Jimenez W, et al. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology 1998;27:35–41

    Article  PubMed  CAS  Google Scholar 

  106. Ottesen LH, Aagaard NK, Kiszka-Kanowitz M, Rehling M, Henriksen JH, Pedersen EB, et al. Effects of a long-acting formulation of octreotide on renal function and renal sodium handling in cirrhotic patients with portal hypertension: a randomized, double-blind, controlled trial. Hepatology 2001;34(3):471–477

    Article  PubMed  CAS  Google Scholar 

  107. Duvoux C, Zanditenas D, Hezode C, Chauvat A, Monin JL, Roudot-Thoraval F, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study. Hepatology 2002;36(2):374–380

    Article  PubMed  CAS  Google Scholar 

  108. Pomier-Layrargues G, Paquin SC, Hassoun Z, Lafortune M, Tran A. Octreotide in hepatorenal syndrome: a randomized, double-blind, placebo-controlled, crossover study. Hepatology 2003;38(1):238–243

    Article  PubMed  CAS  Google Scholar 

  109. Angeli P, Volpin R, Gerunda G, Craighero R, Roner P, Merenda R, et al. Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology 1999;29(6):1690–1697

    Article  PubMed  CAS  Google Scholar 

  110. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2004;40(1):55–64

    Article  PubMed  CAS  Google Scholar 

  111. Van Obbergh L, Vallieres Y, Blaise G. Cardiac modifications occurring in the ascitic rat with biliary cirrhosis are nitric oxide related. J Hepatol 1996;24(6):747–752

    Article  PubMed  Google Scholar 

  112. Luca A, Feu F, Garcia-Pagan JC, Jiménez W, Arroyo V, Bosch J, et al. Favorable effects of total paracentesis on splanchnic hemodynamics in cirrhotic patients with tense ascites. Hepatology 1994;20:30–33

    PubMed  CAS  Google Scholar 

  113. Ruiz del Arbol L, Monescillo A, Jimenez W, Garcia-Plaza A, Arroyo V, Rodes J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997;113:579–586

    Article  PubMed  CAS  Google Scholar 

  114. Bernardi M, Trevisani F, Gasbarrini A, Gasbarrini G. Hepatorenal disorders. Role of the renin-angiotensin-aldosterone system. Semin Liver Dis 1994;14:23–34

    Article  PubMed  CAS  Google Scholar 

  115. Gentilini P, Romanelli RG, La Villa G, Maggiore Q, Pesciullesi E, Cappelli G, et al. Effects of low-dose captopril on renal hemodynamics and function in patients with cirrhosis of the liver. Gastroenterology 1993;104:588–594

    PubMed  CAS  Google Scholar 

  116. Schneider AW, Kalk JF, Klein CP. Effect of losartan, an angiotensin II receptor antagonist, on portal pressure in cirrhosis. Hepatology 1999;29(2):334–339

    Article  PubMed  CAS  Google Scholar 

  117. Garcia-Tsao G. Angiotensin II receptor antagonists in the pharmacological therapy of portal hypertension: a caution. Gastroenterology 1999;117(3):740–742

    Article  PubMed  CAS  Google Scholar 

  118. Epstein M, Weitzman RE, Preston S, Denunzio AG. Relationship between plasma arginine vasopressin and renal water handling in decompensated cirrhosis. Miner Electrolyte Metab 1984;10:155–165

    PubMed  CAS  Google Scholar 

  119. Guyader D, Patat A, Ellis-Grosse EJ, Orczyk GP. Pharmacodynamic effects of a nonpeptide antidiuretic hormone V2 antagonist in cirrhotic patients with ascites. Hepatology 2002;36(5):1197–1205

    Article  PubMed  CAS  Google Scholar 

  120. Fernandez-Llama P, Turner R, Dibona G, Knepper MA. Renal expression of aquaporins in liver cirrhosis induced by chronic common bile duct ligation in rats. J Am Soc Nephrol 1999;10(9):1950–1957

    PubMed  CAS  Google Scholar 

  121. Claria J, Jimenez W, Arroyo V, La Villa G, Lopez C, Asbert M, et al. Effect of V-1-vasopressin receptor blockade on arterial pressure in conscious rats with cirrhosis and ascites. Gastroenterology 1991;100:494–501

    PubMed  CAS  Google Scholar 

  122. Morales J, Moitinho E, Abraldes JG, Fernandez M, Bosch J. Effects of the V1a vasopressin agonist F-180 on portal hypertension-related bleeding in portal hypertensive rats. Hepatology 2003;38(6):1378–1383

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Physiology 239, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, 2650, Hvidovre, Denmark

    Søren Møller & Jens H. Henriksen

  2. Department of Medical Gastroenterology 439, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, 2650, Hvidovre, Denmark

    Flemming Bendtsen

Authors
  1. Søren Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens H. Henriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Flemming Bendtsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Søren Møller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Møller, S., Henriksen, J.H. & Bendtsen, F. Pathogenetic background for treatment of ascites and hepatorenal syndrome. Hepatol Int 2, 416–428 (2008). https://doi.org/10.1007/s12072-008-9100-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-008-9100-3

Keywords

Search

Navigation