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Ascites and Renal Dysfunction in Liver Disease: Pathogenesis, Diagnosis, and Treatment

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It has been six years since we published the fi rst edition of Ascites and Renal Dysfunction in Liver Disease. Since then, signifi cant advances have been made in the pathogenesis of circulatory and renal dysfunction that occur in the setting of chronic liver diseases, particularly cirrhosis.

Specifi cally, the role of vasodilatory factors, particularly nitric oxide, has been investigated extensively. Moreover, there is increased recognition of the mechanistic role of impaired heart function on the circulatory dysfunction of liver failure. In this second edition of Ascites and Renal Dysfunction in Liver Disease, these advances in pathogenetics are described in specifi c chapters.

Besides this increased knowledge on pathophysiology, major advances have been made in the clinical management of renal dysfunction in liver disease. A new therapeutic method, transjugular intravenous portosystemic shunts, has emerged for patients with ascites refractory to diuretic therapy. A large number of nonrandomized studies (as well as several randomized trials) have been published concerning the effects of this therapeutic approach. For the fi rst time ever, an effective treatment has been described to treat hepatorenal syndrome in patients with cirrhosis, namely administration of vasoconstrictor drugs. Moreover, there are studies showing how hepatorenal syndrome can be effectively prevented in specifi c settings such as spontaneous bacterial peritonitis and alcoholic hepatitis. Finally, specifi c antagonists of the V2 vasopressin receptor are in advanced stages of clinical development. These drugs might prove to be useful in the management and prevention of dilutional hyponatremia, a complication for which there is currently no effective therapy. All these new topics, as well as other topics on the management of liver disease, are covered in this second edition.

The layout and look of the book have changed from the previous edition. The book has been divided into two sections: the fi rst (Parts 1, 2 and 3) describes the pathophysiology of circulatory and renal abnormalities, whilst the second (Parts 4–7) relates to clinical management of patients. We hope this will make the book easier to read when looking for either pathogenic factors or answers to clinical questions.

Finally, we would like to acknowledge the work of the authors of the chapters, who are internationally recognised specialists in their fi elds and have done a tremendous job in summarizing the different topics inside the page limits. We thank both Nicki van Berckel and Janet Darling for their administrative assistance, and Blackwell Publishing for making the book appealing to the readers.

We hope that this second edition of Ascites and Renal Dysfunction in Liver Disease will be helpful not only to clinical researchers interested in complications of cirrhosis, but also to those clinicians – whether they be gastroenterologists, transplant hepatologists, nephrologists, or internists – caring for patients with liver diseases.
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