Current clinical perspectives and implications of cirrhotic ascites in China
In recent years, domestic research efforts have significantly advanced our understanding of the pathogenesis of cirrhotic ascites and led to development of new and improved methods of diagnosis and treatment.Unfortunately, the studies have produced underlying mechanisms remain unknown systematic studies to compare the new and traditional methods are lacking.There is an urgent need to address the following topics and related issues: (1) The mechanism of sodium retention: Sodium restriction treatment regimens and diuretic therapy have not only failed to inhibit activity of the kidney-angiotensin-aldosterone system (RAAS) , but stricter salt restriction has produced stronger RAAS activity.However, correcting hyponatremia effectively inhibited the RAAS activity. (2) The causes and effects of hepatorenal syndrome (HRS) : The established theory that cirrhotic ascites result from disorders of vasoactive substances leading to hypovolemia and subsequent HRS was not shown in patients.However, cirrhosis ascites were shown to be associated with sodium restriction and diuretic status, which is newly theorized to lead to the hypovolemia-induced HRS. (3) Inconsistencies in established management guidelines: Some rules of the USA guidelines for therapy of cirrhotic ascites lack a theoretical basis, resulting in contradictions in diagnosis and treatment, which may also be explained by ethnic-specific features.Thus, it is necessary to formulate a new set of guidelines for diagnosis and treatment of cirrhotic ascites in Chinese patients based on a comprehensive understanding of the underlying molecular and biological pathogenic mechanisms.
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