Nephrogenicascites can be cured by strict salt restriction, effective dialysis and persistent ultrafiltration in contrary to general belief. Other causes of ascites include malignancy, heart failure, tuberculosis, alcoholic hepatitis, budd. Ascites means pathologic fluid collection within the abdominal cavity. Management of adult patients with ascites caused by cirrhosis. If observed for 10 years, approximately 60% of patients with cirrhosis develop ascites requiring therapy. Ascitic fluid analysis in the differential diagnosis of. Other causes for ascites were ruled out in each case by peritoneoscopy, peritoneal fluid. Ebscohost serves thousands of libraries with premium essays, articles and other content including surgical correction of nephrogenic ascites in a renal transplant recipient. Signs and symptoms of ascities include shortness of breath, and abdominal pain, discomfort, or bloating. Mar 15, 2014 ascites is one of the most frequent complications of cirrhosis and portal hypertension. The development of ascites is associated with a poor prognosis and.
Contributing mechanisms may include fluid overload, peritoneal membrane changes not necessarily related to peritoneal dialysis, hypoproteinemia, and lymphatic. Cirrhosis is the most common cause of ascites, representing for 85% of cases. Causes of ascites chronic hepatic disease 81% malignant neoplasia 10% cardiac insufficiency 3% tuberculous peritonitis 2% pancreatic ascites 1% biliary ascites 1% others 1% nephrogenic ascites dialysis 1%. Nephrogenic ascites is a complex diagnostic problem with poorly understood pathophysiology. Five of six patients with chronic renal failure and ascites have been maintained with, or are presently undergoing, intermittent hemodialysis. Itspathogenesis remains unknown, has limited treatment options, and isassociated with agrave prognosis. In cirrhosis, it is associated with circulatory dysfunction characterized by. The prognosis the life expectancy depends on the cause of ascities. Nephrogenic ascites is a clinical diagnosis defined as persistent ascites in an uremic patient without evidence for a causative specific underlying disease. Ascites has resolved following exploratory laparot omy, bilateral nephrectomy, increased rate and time of dialysis, and most often after successful renal transplanta tion. Pediatric ascites revisited balvir s tomar abstract ascites is the pathologic fluid accumulation within the peritoneal cavity. Nephrogenic ascites associated with maintenance hemodialysis is a complex problem with poorly understood pathophysiology. The treatment is based on increasing number of hemodialysis sessions waiting for a kidney transplant. A poorly understood syndrome nephrogenic ascites ascites ascites is defined as pathological fluid accumulation within the abdominal cavity.
Reinfusion of ascites during hemodialysis as a treatment of massive refractory ascites and acute renal failure. In contrast to ascites due to inflammation or infection, ascites due to portal hypertension produces fluid that is clear and strawcolored, has a low protein concentration, a low polymorphonuclear pmn leukocyte count ascites albumin concentration gradient saag, which is the serum. Ascites is a pathological accumulation of fluid in the peritoneal cavity. Ascites is the abnormal buildup of fluid in the abdomen. Normally, a few millileters of fluid with a composition similar to that of the interstitial space is present between the visceral and parietal serous membrane of the peritoneal space 25. Abc of diseases of liver,pancreas,and biliary system. Effects of a 7day treatment with midodrine in nonazotemic cirrhotic patients with and without ascites.
Development of ascites is a poor prognostic event in the natural history of cirrhosis, with approximately 15 and 44% of patients with ascites. Technically, it is more than 25 ml of fluid in the peritoneal cavity. Chylous ascites pancreatic ascites bile ascites nephrogenic ascites urine ascites ovarian disease causes diseased peritoneum. Ascites is accumulation of fluid in the abdominal cavity. Nephrogenic ascites is a rare condition with a grave prognosis and an unknown but probably multifactorial cause. Nephrogenic diabetes insipidus, which can be inherited or acquired, is characterized by an inability to concentrate urine despite normal or elevated plasma concentrations of the antidiuretic hormone arginine vasopressin. Diagnostic paracentesis was done and found to be exudative with serum ascites albumin gradient saag of 0. The diagnosis of nephrogenic ascites was retained after eliminating other causes of ascites rich in proteins peritoneal tuberculosis, peritoneal carcinomatosis, infected ascites of cirrhosis, budd chiari syndrome, hypothyroidism. The commonest cause of ascites in hemodialysis dependent patients is nephrogenic followed by. About 90% of patients with congenital nephrogenic diabetes insipidus. Other causes for ascites were ruled out in each case by peritoneoscopy, peritoneal fluid studies, and clinical data. The patient was treated by cauterization of the majority of the surface of the allograft, which lead to an involution of the lesions and finally resolution of ascites formation. Accumulation of fluid within the peritoneal cavity results in ascites.
Sle, systemic lupus erythematosis table 3 main causes of malignant ascites note that peritoneal carcinomatosis accounts for twothirds of patients with malignancyrelated ascites histological type of malignancy %of total origin. Neither the exact cause nor the pathogenesis of ascites formation is. They may have shortness of breath due to elevation of the diaphragm or pleural effusion. Although the pathogenesis of ascites remains elusive, several factors have been considered, including. Portal hypertension hepatic or portal vein occlusion heart failure peritoneal inflammation. We report the cases of nine patients investigated between 1978 and 1985.
Intractable ascites associated with mycophenolate in a. Ascitic fluid represents a state of totalbody sodium and water excess. Marsano, md professor of medicine director of hepatology university of louisville. Successful treatment of the ascites has been unpredict able. Nephrogenic ascites 1174 volumes numbers 1994 tients with esrd without aclear cause 1.
Nephrogenic or dialysis ascites is a clinical diagnosis defined as refractory ascites in patients with endstage renal disease, and presents a complex diagnostic problem with poorly understood pathophysiology and etiology. Intractable ascites in a child during peritoneal dialysis. Short and longterm effectiveness, morbidity, and mortality of peritoneovenous shunt inserted to treat massive refractory ascites of nephrogenic origin analysis of 14 cases. Ascitic fluid analysis in the differential diagnosis of ascites. Pdf reinfusion of ascites during hemodialysis as a. Peritoneal venous shunt can be considered only after failure of other management methods. Kalambokis g, fotopoulos a, economou m, pappas k, tsianos ev. Is nephrogenic ascites related to secondary hyperparathyroidism. Easl clinical practice guidelines on the management of. The word ascites is derived from the greek word askos, which means a bag or sack. Pdf new insights into nephrogenic systemic fibrosis.
The word describes pathologic fluid accumulation within the peritoneal cavity fig. Ascites, encephalopathy, and other conditions jejkrige, i j beckingham ascites ascites is caused by cirrhosis in 75% of cases, malignancy in 10%, and cardiac failure in 5%. Whereas some patients with ascites have peritoneal fluid pmn counts 250 cellsml, all patients with sbp do. N2 five of six patients with chronic renal failure and ascites were maintained with intermittent hemodialysis. The term nephrogenic ascites is preferred as the onset of ascites may occur earlier in the course of renal failure and well before the initiation of dialysis. The accuracy of the physical examination for detecting ascites is only 58%. Assuming that all other causes of ascites have been eliminated which is imperative, then one could call this nephrogenic ascites, or ascites that occurs in patients on dialysis since to imply the kidneys generate it when they are not functioning, does not seem appropriate.
Surgical correction of nephrogenic ascites in a renal. Persistent fluid overload in patients on renal replacement therapy despite good dialysis adequacy or obvious cardiac dysfunction should prompt a search. Diagnosis and management rita sood abstract ascites, the collection of fluid in the peritoneal cavity, occurs with a variety of disease states. University college london, centre for nephrology, royal free hospital, london, uk background. Polyuria, with hyposthenuria, and polydipsia are the cardinal clinical manifestations of the disease. Ascites is the most common major complication of cirrhosis and is an important landmark in the natural history of chronic liver disease. More than one cause may be responsible for the development of ascites multifactorial.
Nephrogenic ascites or ascites associated with renal failure is seen in endstage renal disease inpatients on hemodialysis but has been. Strict volume control in the treatment of nephrogenic ascites. Ascites due to right atrial myxoma in a haemodialysis. The protein content and lactic acid dehydrogenase level of the ascitic fluid in all patients with high, unlike the situation in patients with ascites of uncomplicated cirrhosis. The diagnosis of nephrogenic ascites must be established by exclusion. From division of gastrointestinal and liver diseases, university of southern california. Nephrogenic ascites is a condition characterized by the presence of massive ascites in a patient with esrd.
In the united states, ascites is most often due to portal hypertension resulting from cirrhosis. Ascites is a major complication of cirrhosis, 1 occurring in 50% of patients over 10 years of follow up. Routinely, a cell count and differential should be performed on ascitic. Ascites referred as accumulation of serous fluid in peritoneal cavity, has been attributed to chronic hepatic failure, congestive heart failure, nephritic syndrome, malnutrition, ankylostomiasis and protein losing enteropathy in canine randhawa et al 1980. Guidelines on the management of ascites in cirrhosis. Pdf nephrogenic ascites still an intractable problem. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. A correction to the article derivation of nephrogenic adenomas from renal tubular cells in kidneytransplant recipients, that was published in the august 29, 2002 issue is presented. Unfortunately, there are no good treatments for it. Runyon ascites is the most common of the major complications of cirrhosis. It is one of the earliest and most common complication of chronic liver disease. Successful treatment of ascites of hepatic origin in dog.
Diagnosis and treatment of ascites linkedin slideshare. While 1 year survival in patients who develop ascites is 85%, it decreases to 25% once it has progressed to hyponatraemia, refractory ascites or hrs 4. The term nephrogenic ascites was coined to describe a syndrome associated with refractory ascites occurring in patients with end stage renal. We report the case of a patient with nephrogenic ascites and concomitant secondary hyperparathyroidism who was resistant to the usual. Nephrogenic ascites is a complex problem with a poorly understood pathophysiology. Management of adult patients with ascites caused by cirrhosis bruce a. Ultrasound for detection of ascites and for guidance of the. Ascites associated with endstage renal disease american. Ascites is defined as an accumulation of fluid in the peritoneal cavity caused by alcohol abuse, cirrhosis, liver disease, cancers, heart failure, nephrotic syndrome, pancreatic disease, and many other things.
Ascites hepatic and biliary disorders merck manuals. Nephrogenic ascites jama internal medicine jama network. Morbidity and potential mortality of this complex problem are significant. Ascities treatment guidelines depend upon the condition causing ascites. Its etiology includes gastrointestinal, genitourinary, cardiac and metabolic disorders, infections. Joubran, md c nephrogenic ascites is a complex problem with a poorly understood pathophysiology. Ascites should be treated with salt restriction and diuretics. Successful treatment of ascites depends upon an accurate diagnosis of its cause table 1 and table 2 and table 3 and. The value of a cell count and bacterial culture of the ascitic fluid is not disputed, but the role of biochemical. Nephrogenic diabetes insipidus affected or carrier clinical background nephrogenic diabetes insipidus ndi is characterized by inability of the kidneys to concentrate urine despite the presence of arginine vasopressin avp, also known as antidiuretic hormone adh. After detailed workup, hepatic, cardiac, infectious and malignant causes for ascites were ruled out. Carcinomatosis sometimes chylous ascites ovarian cancer nephrogenic ascites nephrotic syndrome pancreatic ascites other schistosomiasis, noncirrhotic portal htn, polycystic liver disease.
Although the underlying cause of the ascites is often thought to be clinically obvious, it is important to establish a definitive diagnosis. The serum ascites albumin gradient is important because it is paramount to determine if the ascites is due to portal hypertension or otherwise, since the diagnostic pathways are different for each cause. This insensitivity to avp results in polyuria, polydipsia, low. The most useful parameter for classifying ascites is the serum ascites albumin gradient saag. We report 4 pediatric patients investigated between 1986. Water restriction if serum na ascites of nephrogenic origin analysis of 14 cases. Other common causes include malignancy and heart failure. We report the case of a patient with nephrogenic ascites and concomitant secondary hyperparathyroidism who was resistant to the usual treatment but had a complete resolution after subtotal parathyroidectomy. This is a temporary file and hence do not link it from a website, instead link the url of this page if you wish to link the pdf. There is limited prospective data on nephrogenic ascites. Pdf nephrogenic systemic fibrosis nsf is a relative new disease affecting. Development of refractory ascites during amiodarone.
Because many diseases can cause ascites, in particular cirrhosis, samples of ascitic. Improvement of refractory ascites in cirrhotic patients on. Morbidity and eventual mortality from this ongoing problem are significant. Nephrogenic ascites associated with maintenance haemodialysis ccf, congestive cardiac failure. Ascitic fluid samples are frequently sent to the laboratory for analysis. We report 4 pediatric patients investigated between 1986 and 1990. There is limited prospective data on nephrogenic ascites from the indian subcontinent. Complications can include spontaneous bacterial peritonitis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation.
Chapter 4 evaluation of in vivo anticancer activity of purified pteridine using daltons lymphoma ascites tumor model in mice 91. In most patients the history and examination will give valuable clues to the cause of the ascites for. Nephrogenic ascites is an entity that manifests as refractory ascites in patients with endstage renal disease, where portal hypertensive, infectious, and malignant. Chapter 4 evaluation of in vivo anticancer activity of purified pteridine using daltons lymphoma ascites tumor model in mice 93. Common causes of ascites are liver disease or cirrhosis, cancers,and heart failure. Patients frequently present with hypertension, moderate to massive ascites, minimal extremity edema, cachexia, and a history of dialysisassociated. Cirrhotic ascites forms as the result of a particular sequence of events. Patients with refractory ascites have worse survival than patients with diureticresponsive ascites survival probability 1. True ascites refer to accumulation of serous or serosanguinous fluid in peritoneal. The diagnosis of ascites of nephrogenic origin was made.
Neither the exact cause nor the pathogenesis of ascites formation is clearly understood. Ascites is a pathophysiological condition with increased fluid in the intraperitoneal space. Contributing mechanisms may include peritoneal membrane changes, fluid overload, hyperparathyroidism, reduced lymphatic drainage, heart failure and. Ascites balvir s tomar definition ascites is of greek derivation askhos which refers to a bag or sack. Other causes for ascites were ruled out in each case by peritoneoscopy, peritoneal fluid studies, and. Treatment of ascites diuretics general therapeutic goal without edema. Ascites is a condition, usually caused by cirrhosis, where excess fluid builds up in your abdomen. Diagnosis and course of nephrogenic ascites jama internal.