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

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.