The onset of ascites in a patient with cirrhosis signals the beginning of compromised quality and expectancy of life. This common complication of end-stage liver disease results from a complex pathogenesis that leads to marked renal sodium and water retention. The hepatorenal syndrome is characterized by progression of the renal dysfunction of cirrhotic ascites to a more advanced level of functional renal failure. The evolution of our understanding of the pathogenesis of cirrhosis has been beset by chicken-and-egg conundrums, including dueling theories of circulatory "overflow" as compared with "underfill." The almost metaphysical (but ingenious) concept of reduced "effective blood volume," . . .
http://content.nejm.org/cgi/content/full/354/25/2733
Ascites and Renal Dysfunction in Liver Disease: Pathogenesis, Diagnosis, and Treatment
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