Current management and novel therapeutic strategies for refractory ascites and hepatorenal syndrome.
The circulatory disturbances seen in advanced cirrhosis lead to the development of ascites, which can become refractory to diet and medical therapy. These abnormalities may progress and cause a functional renal failure known as the hepatorenal syndrome. Management of refractory ascites and hepatorenal syndrome is a therapeutic challenge, and if appropriate, liver transplantation remains the best treatment. New therapeutic options have recently appeared, including the transjugular intrahepatic portosystemic shunt and selective splanchnic vasoconstrictor agents, which may improve renal function and act as a bridge to transplantation.
Suzuki
H
H
Department of Gastroenterology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
Stanley
A J
AJ
D001201:Ascites / Q000150:complications / Q000628:therapy*; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019152:Paracentesis / Q000379:methods; D010536:Peritoneovenous Shunt / Q000379:methods; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011465:Prostaglandins, Synthetic / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D011465:Prostaglandins, Synthetic; D014662:Vasoconstrictor Agents; D009320:Atrial Natriuretic Factor; D004298:Dopamine