Why spironolactone in cirrhosis

Ok, enter the new millennium. Why did we get to where we are now? In , Santos et al. In , Angeli et al. As you can see from the above, both approaches single-agent spironolactone first, or combination therapy have their merits in different situations. Transplant Hepatologist, UNC. The Why? Hersh Shroff. In patients who do not respond to aldosterone antagonists…,or in patients who develop hyperkalemia, furosemide should be added….

Why does ascites even form? Take Home Points Overall, the differences between sequential therapy starting with spironolactone and combination therapy are small but might have impacts in different settings In outpatients with new ascites, spironolactone alone is a reasonable starting point effective, gentle, minimizes of medications In outpatients with recurrent ascites or with failure spironolactone alone, combination therapy is the best option In inpatients, combination therapy is probably preferable effective, probably faster, patients are likely to have more advanced disease, easier to perform close lab monitoring.

Use of a new diuretic agent Metolazone in patients with edema and ascites. Lieberman, F. The use of ethacrynic acid in patients with cirrhosis and ascites. Moult, P. Use of bumetanide in the treatment of ascites due to liver disease. Gut, ; 15 : Arroyo, V. Renin, aldosterone and renal hemodynamics in cirrhosis with ascites. Bosch, J. Gastroenterology, ; Gross, J. Effects of aldosterone and potassium sparing diuretics on electrical potential differences across the distal nephron.

Vandewalle, A. Aldosterone binding along the rabbit nephron; an autoradiographic study on isolated tubules. Hass, J. Collecting duct sodium, reabsorbtion in desoxycorticosterone- treated rats. Rosoff, L. Studies of Renin and aldosterone in cirrhotic patients with ascites. Epstein, M. Characterization of the renin-aldosterone system in decompensated cirrhosis. Wilkinson, S.

Sodium retention, the renin-angio-tensin-aldosterone system and the intrarenal distribution of plasma flow in cirrhosis with unimpaired renal function, in the kidney in liver disease. Amsterdam Elsevier North-Holland, , p. Giuseffi, J. Effect of bilateral adrenalectomy in a patient with massive ascites and postnecrotic cirrhosis. Deranged sodium homeostasis in cirrhosis. Blendis, L. Gross, G. Functional comparison of the distal convoluted tubule and the cortical collecting tubule.

Clin Invest. Schwartz, GJ. Mineralocorticoid effects on cation transport by cortical collecting tubules in vitro. Good, D. Luminal influences on potassium secretion; sodium concentration and fluid flow rate. Wrote the paper: WL. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Objective Aldosterone, one of the main peptides in renin angiotensin aldosterone system RAAS , has been suggested to mediate liver fibrosis and portal hypertension.

Methods Liver cirrhosis was induced by bile duct ligation BDL. Results Treatment with spironolactone significantly lowered portal pressure. Introduction In cirrhosis, increased intrahepatic resistance is the primary event causing portal hypertension [1] — [3].

Treatment regimens Billary hepatic fibrosis was induced by double ligation and transection of the common bile duct, as previously described [12] , [13]. Tissue collection and biochemical analyses After the indicated periods, blood was obtained for the measurement of biochemical parameters AST, ALT, and bilirubin using standard methods.

Hepatic hydroxyproline determination Collagen content of the liver was quantified using hydroxyproline detection kit Jiancheng Institute of Biotechnology, Nanjing, China according to the manufacturer' s instructions. Western Blotting Western blotting was performed as described previously [11]. In situ liver perfusion In situ liver perfusion was performed as previously described [21]. Results Effect of spironlactone on liver fibrosis BDL caused significant histological changes, including a distortion of the normal architecture, expansion of portal tracts with extensive bile-duct proliferation and deposition of collagen Figure 1A.

Download: PPT. Figure 1. Figure 2. Spironolactone Sp downregulates type I collagen expression and reduces hydroxyproline content in BDL rats. Table 1. Figure 3. Effect of spironolactone on the inflammatory genes and aldosterone synthase gene expressions Since spironolactone is suggested to be an inflammatory inhibitor, it is worthwhile to investigate whether the protective effect is mediated through its anti-inflammatory function.

Figure 4. Effects of spironolactone on the inflammatory genes and aldosterone synthase gene expressions in BDL-treated rats. Figure 5. Sprionolactone Sp inhibits the phosphorylation of moesin in BDL- treated rats. Figure 6. Sprionolactone Sp increased the phosphorylation of vasp in BDL- treated rats. Effect of spironolactone on portal hypertension and intrahepatic resistance As expected, the portal vein flow was significantly elevated in BDL rats compared with that in sham- operated rats.

Figure 7. Spironolactone Sp improves portal pressure and lower portal vein resistance in BDL- treated rats. Discussion Spironlacton, an aldosterone antagonist, has been extensively used as a minor diuretic in achieving volume homeostasis. References 1. Portal hypertension. J Hepatol — View Article Google Scholar 2.

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