Management of refractory ascites and hepatorenal syndrome

Amy N. Sussman, Thomas D. Boyer

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


One of the most common manifestations of the development of portal hypertension in the patient with cirrhosis is the appearance of ascites. Once ascites develops, the prognosis worsens and the patient becomes susceptible to complications such as bacterial peritonitis, hepatic hydrothorax, hyponatremia, and complications of diuretic therapy. As the liver disease progresses, the ascites becomes more difficult to treat and many patients develop renal failure. Most patients can be managed by diuretics which, when used correctly, will control the ascites. Spontaneous bacterial peritonitis can be treated effectively, but portends a worse prognosis. Once the ascites becomes refractory to diuretics, liver transplantation is the best option, although use of transjugular intrahepatic portosystemic shunts will control the ascites in many patients. Lastly, the development of hepatorenal syndrome indicates the patient's liver disease is advanced, and transplantation again is the best option. However, use of vasoconstrictors may improve renal function in some patients, helping in their management while they await a liver transplant.

Original languageEnglish (US)
Pages (from-to)17-25
Number of pages9
JournalCurrent gastroenterology reports
Issue number1
StatePublished - Feb 2011


  • Ascites
  • Cirrhosis
  • Hepatic hydrothorax
  • Hepatorenal syndrome
  • Hyponatremia
  • Midodrine
  • Octreotide
  • Refractory ascites
  • Renal failure
  • Terlipressin

ASJC Scopus subject areas

  • Gastroenterology


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