The Saga of Ascites and Albumin

59 y/o M with HCV, ETOH and Cirrhosis readmitted from rehab with worsening ascites and renal function.

Important questions that were discussed.

Ascites: Pathophysiology of Ascites? The importance of splanchnic vasodilitation in circulatory dysfunction?  Treatment options based on pathophysiology? How infection worsens splanchnic vasodiliation and thus ascites?

Renal and Circulatory Dysfunction in Cirrhosis: Current Management and Future Perspectives

The Pathogenesis and Treatment of Hepatorenal

 

Albumin: The role of albumin in cirrhosis with respect to large volume paracentesis, SBP and prevention of hepatorenal syndrome.  Pivotal Papers influencing our perception of Albumin. The Spanish have been way ahead of us.

The Spanish:

Randomized Comparative Study of Theraputic Paracentesis with and without Intravenous Albumin in Cirrhosis

Randomized Trial of Albumin, Dextran 40, Polygeline in Cirrhotics Patients with Ascites Treated by Paracentesis

The Americans:

Albumin & Hypovolemia: Is the Cochrane Review to be trusted?

Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and SBP