Ascites is one of the earliest and most common complications of patien
ts with cirrhosis, and is associated with complications such as diluti
onal hyponatraemia, renal dysfunction and spontaneous bacterial perito
nitis. The treatment of ascites has been based on the combination of a
low-sodium diet and the administration of diuretics. The reintroducti
on of paracentesis and the recent introduction of the transjugular int
rahepatic portosystemic shunt (TIPS) are the most relevant innovations
in the treatment of ascites during the past 2 decades. The developmen
t of ascites is closely related to renal disturbances of functional or
igin, including the hepatorenal syndrome. A new definition of hepatore
nal syndrome has been proposed recently and 2 different types have bee
n defined (type I or progressive, and type II or stable). Although no
effective therapy exists for this syndrome, the use of therapeutic met
hods (TIPS, vasoconstrictor agents, dialysis) to temporarily improve r
enal function and act as a 'bridge' to liver transplantation, may be o
f most benefit. The use of potent and safe antibiotics has improved th
e resolution rate and survival of patients with spontaneous bacterial
peritonitis. In addition, the use of oral antibiotics will simplify th
e management of this condition in the near future. Finally, prophylact
ic antibiotic regimens represent a major step forwards in the preventi
on of spontaneous bacterial peritonitis in subsets of cirrhotic patien
ts with a great risk of developing this complication.