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Diagnosis and management of ascites and hepatorenal syndrome (acute kidney injury) in cirrhosis

O'Brien, A; (2019) Diagnosis and management of ascites and hepatorenal syndrome (acute kidney injury) in cirrhosis. Medicine , 47 (12) pp. 828-832. 10.1016/j.mpmed.2019.09.013. Green open access

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Abstract

Ascites is the most common complication of cirrhosis and represents a watershed moment, with patients' median survival falling from >12 years for compensated cirrhosis to approximately 2 years. Treatment aims to reduce sodium intake and increase renal sodium excretion with the aldosterone antagonist spironolactone, starting at 100 mg daily; 60% respond. Renal dysfunction affects as many as 20% of hospitalized patients and is a strong predictor of mortality. Liver transplantation represents the best treatment for hepatorenal syndrome (HRS) yet is rarely available, and a combination of vasoconstrictors and albumin represent the mainstay of treatment. Terlipressin is the most widely used vasoconstrictor, leading to HRS resolution in >50% of patients. The role of transjugular intrahepatic portosystemic shunt insertion or renal replacement therapy for HRS remains uncertain, with further studies needed. These patients are very fragile with a high mortality. Many patients require regular ascitic drainage every 2–4 weeks that is best achieved in a day-case setting. Diuretic medication requires frequent dose adjustment because of coexistent renal impairment. Where ascites persists, liver transplantation or TIPPS should be considered. Finally, given the poor prognosis for many patients, it is important to address end-of-life planning and palliation where appropriate.

Type: Article
Title: Diagnosis and management of ascites and hepatorenal syndrome (acute kidney injury) in cirrhosis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.mpmed.2019.09.013
Publisher version: https://doi.org/10.1016/j.mpmed.2019.09.013
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Albumin; diuretics; infection; MRCP; splanchnic vasodi-latation; systemic inflammation; terlipressin
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10087901
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