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Pharmacotherapy of Ascites Associated with Cirrhosis

  • Practical Therapeutics
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Summary

Cirrhotic patients frequently develop ascites during the course of their disease. The appearance of ascites is the final consequence of profound disturbances in systemic and splanchnic haemodynamics, and in renal and hormonal function. The alterations in renal function consist of a decreased ability to excrete sodium and water, and in more severe cases, a reduction in renal blood flow and glomerular filtration rate. No effective drug therapy is yet available for water retention and renal failure in these patients. Sodium retention, however, may be treated by the administration of diuretics. The diuretics most commonly used in the treatment of cirrhotic patients with ascites are loop diuretics, particularly furosemide (frusemide), and distal, or ‘potassium-sparing’ diuretics such as spironolactone. Although furosemide has a much greater natriuretic potency than spironolactone in healthy individuals, studies in cirrhotic patients with ascites have shown that spironolactone is more effective than furosemide in the elimination of ascites. Nowadays, however, therapeutic paracentesis associated with plasma expanders has replaced diuretic therapy as the initial treatment for cirrhotic patients hospitalised with tense ascites since it is more effective and is associated with a lower rate of complications than diuretic therapy. Diuretics should be given after the elimination of ascites by paracentesis to avoid the reaccumulation of the abdominal fluid. Only cirrhotic patients with mild ascites should be treated initially with diuretics.

Cirrhotic patients with ascites frequently develop a spontaneous infection of the ascitic fluid which is usually caused by Gram-negative bacilli from enteric origin and has a great tendency to recur after therapy. The antibiotics of choice for this infection are third-generation cephalosporins. Long term administration of norfloxacin, which causes a selective elimination of Gram-negative bacilli from the intestinal flora, is effective in preventing the recurrence of ascites infection in these patients.

Finally, cirrhotic patients with ascites are prone to develop renal failure when treated with a variety of pharmacological agents, particularly aminoglycosides and nonsteroidal anti-inflammatory drugs. The administration of the latter drugs may also cause dilutional hyponatraemia and refractory ascites since they induce water retention and impair the renal response to diuretics.

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References

  • Alexander EA, Levinsky NG. An extrarenal mechanism of potassium adaptation. Journal of Clinical Investigation 47: 740–748 1968

    PubMed  CAS  Google Scholar 

  • Antillon M, Comminelli F, Reynolds TB, Zipser RD. Comparative acute effects of diflunisal and indomethacin on renal function in patients with cirrhosis and ascites. American Journal of Gastroenterology 84: 153–155 1989

    PubMed  CAS  Google Scholar 

  • Ariza J, Gudiol F, Dolz C, Xiol J, Linares J, et al. Evaluation of aztreonam in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis. Hepatology 6: 906–910 1986

    PubMed  CAS  Google Scholar 

  • Arroyo V, Bosch J, Casamitjana R, Cabrera J, Rivera F, et al. Use of piretanide, a new loop diuretic, in cirrhosis with ascites. Gut 21: 855–859 1980

    PubMed  CAS  Google Scholar 

  • Arroyo V, Epstein M, Gallus G, Gentilini P, Ring-Larsen H, et al. Refractory ascites: mechanism and treatment. Gastroenterology International 2: 195–207 1989

    Google Scholar 

  • Arroyo V, Ginès P, Jiménez W, Rodés J. Ascites, renal failure, and electrolyte disorders in cirrhosis: pathogenesis, diagnosis, and treatment. In McIntyre N et al. (Eds) Oxford textbook of clinical hepatology, Oxford Medical Press, Oxford, in press, 1991

    Google Scholar 

  • Arroyo V, Ginès P, Planas R, Panés J, Rodés J. Management of patients with cirrhosis and ascites. Seminars in Liver Disease 6: 353–369 1986a

    PubMed  CAS  Google Scholar 

  • Arroyo V, Ginès P, Rimola A, Gaya J. Renal function abnormalities, prostaglandins and effects of non-steroidal antiinflammatory drugs in cirrhosis with ascites. An overview with emphasis on pathogenesis. American Journal of Medicine 81(Suppl. 2B): 104–122, 1986b

    PubMed  CAS  Google Scholar 

  • Arroyo V, Planas R, Gaya J, et al. Sympathetic nervous activity, renin-angiotensin system and renal excretion of prostaglandin E2 in cirrhosis. Relationship to functional renal failure and sodium and water excretion. European Journal of Clinical Investigation 13: 271–278 1983

    PubMed  CAS  Google Scholar 

  • Arroyo V, Rodés J. A rational approach to the treatment of ascites. Postgraduate Medical Journal 51: 558–562 1975

    PubMed  CAS  Google Scholar 

  • Atallah A. Interaction of prostaglandins with diuretics. Prostaglandins 18: 369–375 1979

    Google Scholar 

  • Bernardi M, Santini C, Trevisani F. Renal function impairment induced by change in posture in patients with cirrhosis and ascites. Gut 26: 629–635 1985

    PubMed  CAS  Google Scholar 

  • Blaine EH. Basic principles of renal physiology and pharmacology. In Cragoe Jr EJ (Ed.) Diuretics: chemistry, pharmacology, and medicine, pp. 17–48, John Wiley and Sons, New York, 1983

    Google Scholar 

  • Boyer TD, Zia P, Reynolds TB. Effects of indomethacin and prostaglandin A1 in renal function and plasma renin activity in alcoholic liver disease. Gastroenterology 77: 215–222 1979

    PubMed  CAS  Google Scholar 

  • Brater DC, Day B, Burdette A, Anderson S. Bumetanide and furosemide in heart failure. Kidney International 26: 183–189 1984

    PubMed  CAS  Google Scholar 

  • Cabrera J, Arroyo V, Ballesta AM, Rimola A, Gual J, et al. Aminoglycoside nephrotoxicity in cirrhosis: value of urinary beta-2 microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 82: 97–105 1982

    PubMed  CAS  Google Scholar 

  • Campra JL, Reynolds TB. Effectiveness of high-dose spironolactone therapy in patients with chronic liver disease and relatively refractory ascites. Digestive Diseases and Sciences 23: 1025–1030 1978

    CAS  Google Scholar 

  • Corvol P, Claire M, Oblin ME, Geerin K, Rossier B. Mechanism of the antimineralcorticoid effects of spironolactones. Kidney International 20: 1–6 1981

    PubMed  CAS  Google Scholar 

  • Corvol P, Michael P, Menard J, Freifild M, Mahoudeau J. Antiandrogenic effect of spironolactones: mechanism of action. Endocrinology 97: 52–58 1975

    PubMed  CAS  Google Scholar 

  • Diamond JR, Yoburn DC. Nonoliguric acute renal failure associated with low fractional sodium excretion. Annals of Internal Medicine 96: 597–600 1982

    PubMed  CAS  Google Scholar 

  • Dudley FJ, Kanel GC, Wood LJ, Reynolds TB. Hepatorenal syndrome without sodium retention. Hepatology 6: 248–251 1986

    PubMed  CAS  Google Scholar 

  • Eggert RC. Spironolactone diuresis in patients with cirrhosis and ascites. British Medical Journal 4: 401–403 1970

    PubMed  CAS  Google Scholar 

  • Felisart J, Rimola A, Arroyo V, Pérez-Ayuso RM, Quintero E, et al. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology 5: 457–462 1985

    PubMed  CAS  Google Scholar 

  • Fisher JE. Portal-systemic encephalopathy. In Wright R et al. (Eds) Liver and biliary disease, pp. 973–1001, WB Saunders, London, 1985

    Google Scholar 

  • Friedman PA. Biochemistry and pharmacology of diuretics. Seminars in Nephrology 8: 198–212 1988

    PubMed  CAS  Google Scholar 

  • Fuller RK, Khambatta PB, Gobezie GC. An optimal diuretic regimen for cirrhotic ascites: a controlled trial evaluating safety and efficacy of spironolactone and furosemide. Journal of the American Medical Association 237: 972–975 1977

    PubMed  CAS  Google Scholar 

  • Gabow PA, Moore S, Schrier RW. Spironolactone induced hyperchloremic acidosis in cirrhosis. Annals of Internal Medicine 90: 338–340 1979

    PubMed  CAS  Google Scholar 

  • Gatta A, Amodio P, Frigo A, Merkel C, Milani L, et al. Evaluation of renal tubular damage in liver cirrhosis by urinary enzymes and beta-2-microglobulin excretions. European Journal of Clinical Investigation 11: 239–243 1981

    PubMed  CAS  Google Scholar 

  • Gatta A, Angeli P, Caregan L, Menon F, Sacerdoti D, et al. A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients. Hepatology 14: 231–236 1991

    PubMed  CAS  Google Scholar 

  • Ginès P, Arroyo V, Quintero E, Planas R, Bory F, et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites: results of a randomized study. Gastroenterology 93: 234–241 1987

    PubMed  Google Scholar 

  • Ginès P, Arroyo V, Vargas V, Planas R, Casafort F, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. New England Journal of Medicine 325: 829–835 1991

    PubMed  Google Scholar 

  • Ginès P, Quintero E, Arroyo V, Terés J, Bruguera M, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology 7: 122–128 1987

    PubMed  Google Scholar 

  • Ginès P, Rimola A, Marco F, Almela M, Marqués JM, et al. Efecto de la administraciôn de norfloxacino sobre la flora fecal en pacientes cirrôticos. Gastroenterologia y Hepatologia 13: 325–328 1990c

    Google Scholar 

  • Ginès P, Rimola A, Planas R, Vargas V, Marco F, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology 12: 716–724 1990b

    PubMed  Google Scholar 

  • Ginès P, Rimola A, Salmerôn JM, del Pino JI, Ginès A, et al. Utilidad de la administraciôn oral de quinolonas en al profilaxis de la recidiva de la peritonitis bacteriana espontânea en la cirrosis hepática. Gastroenterologia y Hepatologia 13: 329–333 1990a

    Google Scholar 

  • Ginès P, Titó LI, Arroyo V, Planas R, Panés J, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 94: 1493–1502 1988

    PubMed  Google Scholar 

  • Gonzalez G, Arancibia A, Rivas MJ, Caro P, Antezana C. Pharmacokinetics of furosemide in patients with hepatic cirrhosis. European Journal of Clinical Pharmacology 22: 315–320 1982

    PubMed  CAS  Google Scholar 

  • Grange JD, Amiot X, Grange V, Gutmann L, Biour M, et al. Amoxicillin-clavulanic acid therapy of spontaneous bacterial peritonitis: a prospective study of twenty-seven cases in cirrhotic patients. Hepatology 11: 360–364 1990

    PubMed  CAS  Google Scholar 

  • Greger R, Schlatter E, Wittner M. Cellular mechanism of action of furosemide-like diuretics in the thick ascending limb of the loop of Henle. In Puschet JB, Greenber A (Eds) Diuretics: chemistry, pharmacology and clinical applications, pp. 215–221, Elsevier, New York, 1980

    Google Scholar 

  • Gussin T. Potassium-sparing diuretics. Journal of Clinical Pharmacology 17: 651–662 1977

    PubMed  CAS  Google Scholar 

  • Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Disease a Month 31: 1–48 1985

    PubMed  CAS  Google Scholar 

  • Holmes B, Brogden RN, Richards DM. Norfloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 30: 482–513 1985

    PubMed  CAS  Google Scholar 

  • Horisberger JD, Giebisch G. Potassium-sparing diuretics. Renal Physiology 10: 198–220 1987

    PubMed  CAS  Google Scholar 

  • Inoue M, Okajima K, Itoh K, Ando Y, Watanabe N, et al. Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients. Kidney International 32: 198–203 1987

    PubMed  CAS  Google Scholar 

  • Jones K, Castleden CM. A double-blind comparison of quinine sulphate and placebo in muscle cramps. Age and Ageing 12: 155–158 1983

    PubMed  CAS  Google Scholar 

  • Kagawa CM. Blocking the renal electrolyte effects of mineralocorticoids with an orally active steroidal spironolactone. Endocrinology 65: 125–132 1960

    Google Scholar 

  • Kagawa CM, Cella JA, Van Arman CG. Action of new steroids in blocking effects of aldosterone and deoxycorticosterone on salt. Science 126: 1015–1016 1957

    PubMed  CAS  Google Scholar 

  • Kagawa CM, Sturtevant FM, Van Arman CG. Pharmacology of a new steroid that blocks salt activity of aldosterone and deoxycorticosterone. Journal of Pharmacology and Experimental Therapeutics 126: 123–130 1959

    PubMed  CAS  Google Scholar 

  • Karim A. Spironolactone metabolism in man revisited. In Brunner HR (Ed.) Contemporary trends in diuretic therapy, pp. 22–37, Excerpta Medica, Amsterdam, 1986

    Google Scholar 

  • Keller E, Hoppe-Seyler G, Mumm R, Schollmeyer P. Influence of hepatic cirrhosis and end-stage renal disease on pharmacokinetics and pharmacodynamics of furosemide. European Journal of Clinical Pharmacology 20: 27–33 1981

    PubMed  CAS  Google Scholar 

  • Laffi G, Daskalopoulos G, Kronborg I, Hsueh W, Gentilini P, et al. Effects of sulindac and ibuprofen in patients with cirrhosis and ascites. Gastroenterology 90: 182–187 1986

    PubMed  CAS  Google Scholar 

  • Laffi Y, Marra F, Buzzelli Y, Azzena G, Meacci E, et al. Comparison of the effects of torasemide and furosemide in nonazotemic cirrhotic patients with ascites: a randomised doubleblind study. Hepatology 13: 1101–1105 1991

    PubMed  CAS  Google Scholar 

  • Lant A. Diuretics: clinical pharmacology and therapeutic use. Drugs 29: 57–87, 162-188, 1985

    PubMed  CAS  Google Scholar 

  • Liddle GN. Aldosterone antagonists and triamterene. Annals of New York Academy of Sciences 139: 466–470 1966

    CAS  Google Scholar 

  • Lieberman FL, Reynolds TB. The use of ethacrinic acid in patients with cirrhosis and ascites. Gastroenterology 49: 531–538 1965

    PubMed  CAS  Google Scholar 

  • Loriaux DL, Menard R, Taylor A, Pita JC, Santen R. Spironolactone and endocrine dysfunction. Annals of Internal Medicine 85: 630–636 1976

    CAS  Google Scholar 

  • Mirouze D, Zipser RD, Reynolds TB. Effects of inhibitors of prostaglandin synthesis on induced diuresis in cirrhosis. Hepatology 3: 50–55 1983

    PubMed  CAS  Google Scholar 

  • Moore RD, Smith CR, Petty BG, et al. Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside. Lancet 2: 604–606 1978

    Google Scholar 

  • Moult PJA, Lunzer MR, Trash DB, Sherlock S. Use of bumetadine in the treatment of ascites due to liver disease. Gut 15: 988–992 1974

    PubMed  CAS  Google Scholar 

  • Mutschler E, Knauf H. Pharmacokinetics of potassium retaining diuretics. In Puschett JB, Greenberg A (Eds) Diuretics: chemistry, pharmacology, and clinical applications, pp. 290–298, Elsevier, New York, 1984

    Google Scholar 

  • Odlind B. Relationship between tubular secretion of furosemide and its saluretic effects. Journal of Pharmacology and Experimental Therapeutics 208: 515–521 1979

    PubMed  CAS  Google Scholar 

  • Odlind B, Beerman B. Renal tubular secretion and effects of furosemide. Clinical Pharmacology and Therapeutics 27: 784–790 1980

    PubMed  CAS  Google Scholar 

  • Pérez-Ayuso RM, Arroyo V, Camps J, Rimola A, Gaya J, et al. Evidence that renal prostaglandins are involved in renal water metabolism in cirrhosis. Kidney International 26: 72–80 1984

    PubMed  Google Scholar 

  • Pérez-Ayuso RM, Arroyo V, Planas R, Gaya J, Bory F, et al. Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites: relationship between the diuretic response and the activity of the renin-angiotensin-aldoterone system. Gastroenterology 84: 961–968 1983

    PubMed  Google Scholar 

  • Pérez-Ayuso RM, Bory F, Arroyo V, et al. Eficacia de la furosemida en la cirrosis hepática con ascitis. Relación entre la respuesta diurética y el grado de hiperaldosteronismo. Gastroenterología y Hepatologia 4: 402–406 1981

    Google Scholar 

  • Pinzani M, Daskalopoulos G, Laffi G, Gentilini P, Zipser RD. Altered furosemide pharmacokinetics in chronic alcoholic liver disease with ascites contributes to diuretic resistance. Gastroenterology 92: 294–298 1987

    PubMed  CAS  Google Scholar 

  • Planas R, Arroyo V, Rimola A, Perez Ayuso RM, Rodés J. Acetylsalicylic acid suppresses the renal hemodynamic effect and reduces the diuretic action of furosemide in cirrhosis with ascites. Gastroenterology 84: 247–252 1983

    PubMed  CAS  Google Scholar 

  • Planas R, Ginès P, Arroyo V, Llach J, Panés J, et al. Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis: results of a randomized study. Gastroenterology 99: 1–9 1990

    Google Scholar 

  • Pockros PJ, Reynolds TB. Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema. Gastroenterology 90: 1827–1833 1986

    PubMed  CAS  Google Scholar 

  • Quintero E, Ginès P, Arroyo V, Rimola A, Bory F, et al. Paracentesis versus diuretics in the treatment of cirrhotics with tense ascites. Lancet 1: 611–613 1985

    PubMed  CAS  Google Scholar 

  • Quintero E, Ginès P, Arroyo V, Rimola A, Camps J, et al. Sulindac reduces the urinary excretion of prostaglandins and impairs renal function in cirrhosis with ascites. Nephron 42: 298–303 1986

    PubMed  CAS  Google Scholar 

  • Rector WG, Kanel GC, Rakela J, Reynolds TB. Tubular disfunction in the deeply jaundiced patient with hepatorenal syndrome. Hepatology 5: 321–326 1985

    PubMed  Google Scholar 

  • Reeves WB, Molony DA. The physiology of loop diuretics. Seminars in Nephrology 8: 225–233 1988

    PubMed  CAS  Google Scholar 

  • Rimola A. Infections in liver disease. In McIntyre N, et al. (Eds) Oxford textbook of clinical hepatology, Oxford Medical Press, Oxford, in press

  • Rimola A, Bory F, Terés J, Pérez-Ayuso RM, Arroyo V, et al. Oral, nonabsorable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology 5: 463–467 1985

    PubMed  CAS  Google Scholar 

  • Rimola A, Soto R, Bory F, Arroyo V, Piera C, et al. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatology 4: 53–58 1984

    PubMed  CAS  Google Scholar 

  • Ring-Larsen H, Henriksen JH, Wilken C, Clausen J, Pals H, et al. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effects of posture. British Medical Journal 292: 1351–1353 1986

    PubMed  CAS  Google Scholar 

  • Rodés J, Bosch J, Arroyo V. Clinical types and drug therapy of renal impairment in cirrhosis. Postgraduate Medical Journal 55: 492–497 1975

    Google Scholar 

  • Rose LS, Underwook RH, Newmark SR, Kisch ES, Williams GH. Pathophysiology of spironolactone-induced gynecomastia. Annals of Internal Medicine 87: 398–403 1977

    PubMed  CAS  Google Scholar 

  • Rose BD. Diuretics. Kidney International 39: 336–352 1991

    PubMed  CAS  Google Scholar 

  • Runyon BA, Morrissey RL, Hoefs JC, Wyle FA. Opsonic activity of human ascitic fluid: a potentially important protective mechanism against spontaneous bacterial peritonitis. Hepatology 5: 634–637 1985

    PubMed  CAS  Google Scholar 

  • Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology 91: 1343–1346 1986

    PubMed  CAS  Google Scholar 

  • Salerno F, Badalamenti S, Incerti P, et al. Repeated paracentesis and IV albumin infusion to treat ‘tense’ ascites in cirrhotic patients: a safe alternative therapy. Journal of Hepatology 5: 102–108 1987

    PubMed  CAS  Google Scholar 

  • 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, in press, 1991

  • Sansom S, Muto S, Giebisch G. Na-dependent effects of DOCA on cellular transport properties of CCDs from ADX rabbits. American Journal of Physiology 253: F753–F759, 1987

    PubMed  CAS  Google Scholar 

  • Saunders JB, Walters JRF, Davies P, Paton A. A 20-year prospective study of cirrhosis. British Medical Journal 282: 263–266 1981

    PubMed  CAS  Google Scholar 

  • Sawhney VK, Gregory PB, Swezey SE, Blaschke TF. Furosemide disposition in cirrhotic patients. Gastroenterology 81: 1012–1016 1981

    PubMed  CAS  Google Scholar 

  • Schrier RW, Arroyo V, Bemardi M, Epstein M, Henriksen JH, et al. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 8: 1151–1157 1988

    PubMed  CAS  Google Scholar 

  • Shear L, Ching S, Gabuzda GI. Compartimentalization of ascites and edema in patients with hepatic cirrhosis. New England Journal of Medicine 282: 1391–1396 1970

    PubMed  CAS  Google Scholar 

  • Sherlock S. Ascites formation and its management. Scandinavian Journal of Gastroenterology 7 (Suppl.): 9–15, 1970

    CAS  Google Scholar 

  • Sherlock S, Senewiratne B, Scott A, Walker JG. Complications of diuretic therapy in hepatic cirrhosis. Lancet 1: 1049–1053 1966

    PubMed  CAS  Google Scholar 

  • Silvain C, Breux JP, Grollier G, Roufïlneau J, Breq-Giraudon, et al. Les septicémies et les infections du liquide ascitique peuvent-elles être traitées exclusivement par voie orale? Gastroenterologie Clinique et Biologique 13: 335–339, 1989

    PubMed  CAS  Google Scholar 

  • Solis-Herruzo JA, Garcia-Cabezudo J, Diaz-Rubio C, Gômez-Segura A. Estenoz J, et al. Urinary excretion of enzymes in cirrhotics with renal failure. Journal of Hepatology 3: 123–130 1986

    PubMed  CAS  Google Scholar 

  • Strauss E, De Sa MF, Lacet CM, Cartapattida da Silva E, Regina dos Santos W. Standardization of a therapeutic approach for ascites due to chronic liver disease: a prospective study of 100 cases. GED 4: 79–86 1985

    Google Scholar 

  • Suki WN, Stinebaugh BJ, Frommer JP, Eknoyan G. Physiology of diuretic action. In Seldin DW, Giebisch G (Eds) The kidney: physiology and pathophysiology, pp. 2127–2162, Raven Press, New York, 1985

    Google Scholar 

  • Szerlip HM, Weisberg L, Clayman M, Neilson E, Wade JB, et al. Aldosterone-induced proteins: purification and localization of GP65, 70. American Journal of Phsyiology 256: C865–C872, 1989

    CAS  Google Scholar 

  • Titó LI, Rimola A, Ginès P, Llach J, Arroyo V, et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 8: 27–31 1988

    PubMed  Google Scholar 

  • Titó LI, Ginès P, Arroyo V, Planas R, Panés J, et al. Total paracentesis associated with intravenous albumin management of patients with cirrhosis and ascites. Gastroenterology 98: 146–151 1990

    PubMed  Google Scholar 

  • Velazquez H, Wright FS. Effects of diuretic drugs on Na, Cl and K transport in the rat renal distal tubule. American Journal of Physiology 250: F1013–F1023, 1986

    PubMed  CAS  Google Scholar 

  • Villeneuve JP, Verbeeck RK, Wilkinson GR, Branch RA. Furosemide kinetics and dynamics in patients with cirrhosis. Clinical Pharmacology and Therapeutics 40: 14–20 1986

    PubMed  CAS  Google Scholar 

  • Wilson DR, Honrath U, Sonnenberg H. Furosemide action on collecting ducts: effect of prostaglandin synthesis inhibition. American Journal of Physiology 244: F666–F673, 1983

    PubMed  CAS  Google Scholar 

  • Wolfson JS, Hooper DC. Norfloxacin: a new targeted fluoroquinolone antimicrobial agent. Annals of Internal Medicine 108: 238–251 1988

    PubMed  CAS  Google Scholar 

  • Yamada S, Reynolds TB. Amiloride (MK-870), a new antikaliuretic diuretic. Comparison to other antikaliuretic diuretics in patients with liver disease and ascites. Gastroenterology 59: 833–841 1970

    PubMed  CAS  Google Scholar 

  • Zipser RD, Hoefs JC, Speckart PF, Zia PK, Horton R. Prostaglandins: modulators of renal function and pressor resistance in chronic liver disease. Journal of Clinical Endocrinology Metabolism 48: 895–900 1979

    PubMed  CAS  Google Scholar 

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  1. Liver Unit, Hospital Clinic i Provincial, University of Barcelona, Barcelona, Spain

    Pere Ginès, Vicente Arrovo & Joan Rodés

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Ginès, P., Arrovo, V. & Rodés, J. Pharmacotherapy of Ascites Associated with Cirrhosis. Drugs 43, 316–332 (1992). https://doi.org/10.2165/00003495-199243030-00003

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