Diagnostic usefulness of the random urine Na/K ratio in predicting therapeutic response for diuretics in cirrhotic patients with ascites

Basel, Mohamed El; Mazny, Ahmed El; Emam, Ahmed; Shehaby, Amal El

doi:10.4103/1687-4625.162394

Cited by 2 publications

(2 citation statements)

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“…The higher prevalence of diuretic resistant ascites in this study can be explained by many reasons: firstly, all of our patients had severe cirrhosis (Child Pugh B or C) and ascites was grade 3 in majority (58.2%) of our patients, secondly, we included patients with impaired kidney function, serum creatinine up to 3.5mg/dl. Also, in a study by Elbasel and others in Cairo University at 2015the prevalence of diuretics resistant ascites was 30% (8) . Moreover, a Tunisian study included 124 cirrhotic patients, prevalence of resistant ascites was 21.8% (9) .…”

Section: Resultsmentioning

confidence: 92%

Assessment of the Response to an Experimental Dose of Furosemide in Patients with Decompensated Chronic Liver Disease and Ascites

Khedr

Hassan

Ali

2018

Suez Canal University Medical Journal

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Background: Ascites due to cirrhosis can be mobilized with a treatment regimen consisting of dietary sodium restriction and oral diuretics. Ascites resistant to diuretic therapy requests adopting balanced approaches in its management but treatment responses are variable and frequently difficult to assess. Aim: To quantify response to an experimental dose of furosemide in patients with decompensated chronic liver disease and ascites. Subjects and Methods: a pre-post intervention study was carried out on 110 patients with ascites grade 2 or 3 receiving IV furosemide, and response was assessed by Absolute and percentage weight loss, the average daily weight loss, average daily urine output and % deviation from the pre-intervention 24-h output, 24h urinary sodium, and fractional excretion of sodium. Results: our study revealed that 42.7% were responders to furosemide, and presence of moderate positive significant correlation between average daily urine output and average daily weight reduction (r = 0.682), also there is significant relationship between baseline urinary sodium level and FENa and diuretic response. Conclusion: This study revealed that the median point for diuretic response using absolute weight loss is around-0.4kg and average daily urine output around 1500ml, and that there is significant correlation between 24h urinary sodium and diuretic response.

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Section: Resultsmentioning

confidence: 92%

Assessment of the Response to an Experimental Dose of Furosemide in Patients with Decompensated Chronic Liver Disease and Ascites

Khedr

Hassan

Ali

2018

Suez Canal University Medical Journal

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“…Urine samples of each group were also collected at 0–4, 4–8, 8–12, 12–16, 16–20, 20–24, and 24–32 h. To explore how pretreatment with YCHT affected diuretic drugs, urine weight, volume, and sodium and potassium concentrations were monitored at each collection interval. The sodium concentration divided by the potassium concentration corresponded to the effects of spironolactone and showed 75% sensitivity and 92% specificity ( El Basel et al, 2015 ). Urinary sodium and potassium levels were determined using an automated urinalysis analyzer in a clinical laboratory.…”

Section: Methodsmentioning

confidence: 99%

Exploration of sodium homeostasis and pharmacokinetics in bile duct-ligated rats treated by anti-cirrhosis herbal formula plus spironolactone

Hsueh

Tsai²

2023

Front. Pharmacol.

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Renal sodium retention is an essential indicator that is used for the prognosis of cirrhosis with ascites that requires diuretic treatment to restore sodium homeostasis. The diuretic effects of Yin-Chen-Hao-Tang (YCHT) alone or in combination with diuretics for sodium retention in patients with cirrhosis have not been investigated. This study aimed to investigate the diuretic effects and sodium retention caused by YCHT with spironolactone, from both the pharmacokinetic and pharmacodynamic perspective, in bile duct-ligated rats. The HPLC method was validated and utilized for the pharmacokinetic analysis of rat urine. Urine samples were collected and analyzed every 4 hours for 32 h after oral administration of YCHT at 1 or 3 g/kg daily for 5 days in bile duct-ligated rats. A dose of 20 mg/kg spironolactone was also administered to pretreat the YCHT 1 g/kg or the 3 g/kg group on the 5th day to explore the interaction of the two treatments. Urine sodium, potassium, weight, volume, and spironolactone and canrenone levels were measured to investigate fluid homeostasis after the coadministration. The linearity, precision, and accuracy of the HPLC method were suitable for subsequent urinary pharmacokinetic analyses. The pharmacokinetic parameters in the 1 g/kg YCHT with spironolactone group revealed that the elimination half-life of the spironolactone metabolite, canrenone, was prolonged. In addition, the cumulative excretion amount, the area under the rate curve (AURC), and the maximum rate of excretion (Rmax) were significantly decreased when the spironolactone group was pretreated with 3 g/kg YCHT. Urinary sodium excretion elicited by spironolactone was suppressed by pretreatment with 1 or 3 g/kg YCHT. The 32-hour urine output was not altered by the administration of YCHT alone, but it was significantly decreased by 64.9% after the coadministration of YCHT with spironolactone. The interaction of spironolactone and YCHT was found to decrease urine sodium–potassium and water excretion, and this change was attributed to the decreased level of spironolactone metabolites and possibly the regulation of the renin–angiotensin–aldosterone system by obstructed cirrhosis. The dose adjustment of YCHT or diuresis monitoring should be noted when co-administering YCHT and spironolactone to treat hepatic diseases clinically.

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Diagnostic usefulness of the random urine Na/K ratio in predicting therapeutic response for diuretics in cirrhotic patients with ascites

Cited by 2 publications

References 1 publication

Assessment of the Response to an Experimental Dose of Furosemide in Patients with Decompensated Chronic Liver Disease and Ascites

Assessment of the Response to an Experimental Dose of Furosemide in Patients with Decompensated Chronic Liver Disease and Ascites

Exploration of sodium homeostasis and pharmacokinetics in bile duct-ligated rats treated by anti-cirrhosis herbal formula plus spironolactone

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