Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

Abstract

During the last decade great advances have been made of water retention and dilutional hyponatremia in human cirrhosis. Finally, the field of spontaneous infection of concerning the pathogenesis and treatment of ascites. A new hypothesis on the mechanism of renal dysfunction ascitic fluid (spontaneous bacterial peritonitis) is also experiencing major changes. The demonstration of intestiand ascites formation in cirrhosis has been proposed 1 and this has greatly stimulated research in this area. The nal bacterial translocation in experimental models of cirrhosis, 12 the potential role of cytokines in some discovery of the important role played by the vascular endothelium in the homeostasis of systemic hemodynam-complications associated with this infection, 13 the identification of subgroups of cirrhotic patients predisposed to ics and renal function 2,3 has also opened an important field of research into pathophysiology, and evidence has develop spontaneous bacterial peritonitis, 14 and the effectiveness of selective intestinal decontamination in the been presented implicating endothelial factors in the pathogenesis of systemic circulatory dysfunction in cir-primary and secondary prophylaxis of spontaneous bacterial peritonitis 15,16 are the most relevant developments. rhosis 4,5 and hepatorenal syndrome (HRS). 6 The reintroduction of therapeutic paracentesis has greatly modifiedIn clear contrast to these advances, little attention has been paid to the standardization of the nomenclathe treatment of cirrhotic patients with tense or refractory ascites. 7 The transjugular intrahepatic portosys-ture and diagnostic criteria of different syndromes associated with ascites in cirrhosis. The existence of a temic shunt is another therapeutic tool of potential interest in the management of refractory ascites. 8 The uniform language, however, is essential in modern medicine. It facilitates communication among clinisynthesis of orally-active specific antagonists of the tubular effect of antidiuretic hormone and inhibitors of antidi-cians and researchers and ensures unambiguous diagnoses and more confident prognoses. Moreover, it uretic hormone release will probably add new drugs to the pharmacological armamentarium for patients with improves pathophysiological and therapeutic investigations, simplifies the analysis of therapeutic trials, cirrhosis and ascites. These ''aquaretic drugs,'' which normalize renal water metabolism in experimental cirrhosis and stimulates multicenter studies. and ascites, 9-11 are of potential interest for the treatment PREVIOUS CONSENSUS DEFINITIONS OF HEPATORENAL SYNDROME AND

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

“…In the OT‐0401 study, the diagnosis was based on the 1996 International Club of Ascites criteria 20. In the REVERSE study, the diagnosis was based on International Club of Ascites criteria, which were updated in 2007 1.…”

Improved Quality of Life in Patients with Refractory or Recidivant Ascites after Insertion of Transjugular Intrahepatic Portosystemic Shunts

“…Patient characteristics are shown in table 1. The diagnostic criteria of the International Ascites Club [7]were applied for refractory or recidivant ascites. All patients considered for TIPS were pretreated by repeated paracenteses with intravenous albumin infusion for at least 1 year.…”

It is reasonable to treat patients with type 1 hepatorenal syndrome with midodrine and octreotide

“…Inclusion criteria for both groups were taken from the widely-accepted International Ascites Club's diagnostic criteria for type 1 HRS, which involves demonstration of serum creatinine >1.5 mg/dL despite diuretic withdrawal and plasma volume expansion, as well as exclusion of other etiologies of renal impairment (shock, infection, nephrotoxic agents, etc.). 1 All patients received an average of 120g of albumin for plasma volume expansion in order to make this diagnosis; however, the only statistically significant difference in intervention was the octreotide and midodrine administration.…”