Disturbed volume homeostasis in patients with cirrhosis of the liver

Cirrhosis of the liver is one of the leading causes of death in men during the age of productive employment [1, 2]. Thus, the socio-economic cost of cirrhosis to the patient, his family, and society is incalculable. While the clinical manifestations of cirrhosis have been amply documented, the pathogenesis of the perplexing and common complication of disturbed volume control in this disease has remained elusive. The purpose of this communication is to critically analyze the current view of the mechanism of the circulatory impairment in cirrhosis. It is hoped that a clearer understanding of this disorder in cirrhosis may improve the management of these patients.Patients with moderately advanced cirrhosis often show a characteristic circulatory disturbance, consisting of a tendency to arterial hypotension and avid sodium retention by the kidneys which may lead to edema and formation of ascites. It is these patients rather than those with the so-called hepatorenal syndrome who will be the primary subject of this review. It is, however, likely that patients with hepatorenal syndrome merely represent the extreme spectrum of disturbance of volume control observed in all cirrhotic patients with ascites and renal sodium retention