Mechanisms of water and sodium retention in cirrhosis and the pathogenesis of ascites

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[frontline-hepatitis-awareness] Mechanisms of water and sodium

retention in cirrhosis and the pathogenesis of ascites

Best Pract Res Clin Endocrinol Metab. 2003 Dec;17(4):607-22.

Mechanisms of water and sodium retention in cirrhosis and the pathogenesis

of ascites.

Cardenas A, Arroyo V.

Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical

Center and Harvard Medical School, 330 Brookline Ave, Dana 501, Boston, MA

02215, USA.

Patients with advanced cirrhosis and portal hypertension often show an

abnormal regulation of extracellular fluid volume, resulting in the

accumulation of fluid as ascites, pleural effusion or oedema. The mechanisms

responsible for ascites formation include alterations in the splanchnic

circulation as well as renal functional abnormalities that favour sodium and

water retention. Renal abnormalities occur in the setting of a hyperdynamic

state characterized by an increase cardiac output, a reduction in total

vascular resistance and an activation of neurohormonal vasoactive systems.

This circulatory dysfunction, due mainly to intense arterial vasodilation in

the splanchnic circulation, is considered to be a primary feature in the

pathogenesis of ascites. A major factor involved in the development of

splanchnic arterial vasodilation is nitric oxide (NO), a potent vasodilator

that is elevated in the splanchnic circulation of patients with cirrhosis.

This event decreases effective arterial blood volume and leads to fluid

accumulation and renal function abnormalities which are a consequence of the

homeostatic activation of vasoconstrictor and antinatriuretic factors

triggered to compensate for a relative arterial underfilling. The net effect

is avid retention of sodium and water as well as renal vasoconstriction. The

mechanisms of sodium and water retention and ascites formation in patients

with cirrhosis are discussed in this review.

PMID: 14687592 [PubMed - in process]

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