When is paracentesis indicated in the workup of hepatorenal syndrome (HRS)?

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Answer

Spontaneous bacterial peritonitis (SBP) can present with reversible impairment of renal function, and performing diagnostic paracentesis is strongly recommended in all patients. The role of therapeutic paracentesis/large-volume paracentesis (LVP) in hepatorenal syndrome (HRS) is more controversial in the absence of tense ascites. Concerns exist that further volume depletion may aggravate renal function, due to third spacing in a patient with a known underlying systemic circulatory disturbance. Albumin replacement is recommended in these patients when LVP is performed. Ten grams of albumin is administered for every liter of ascites drained, to a maximum of 50 g of albumin.


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