STEPPED CARE MEDICAL-TREATMENT FOR CIRRHOTIC ASCITES - ANALYSIS OF FACTORS INFLUENCING THE RESPONSE TO TREATMENT

Thirty-two patients with liver cirrhosis and ascites were treated by s tepped care diuretic treatment as follows: step 1, placed on a 35 mEq sodium diet; step 2, given 400 mg/day of potassium canrenoate in addit ion to step 1 treatment; step 3, given 40-80 mg/day of furosemide in a ddition to step 2 treatment. Eleven out of 32 patients (34.4%, group 1 ) and 12 of 21 patients (57.1%, group 2) lost their ascites at step 1 and step 2, respectively. The remaining nine patients (group 3) requir ed step 3 treatment. Basal urinary sodium excretion and creatinine cle arance were significantly lower and beta(2)-microglobulin was signific antly higher in group 3 than those in groups 1 and 2. Elevation of bas al plasma renin activity and norepinephrine was evident only in group 3. In group 1, urinary sodium excretion decreased after the treatment. In group 2, plasma alpha-atrial natriuretic polypeptide was lowered a nd plasma renin activity and norepinephrine were elevated after the tr eatment. These results suggest that basal renal function and plasma re nin activity and norepinephrine levels are useful indices to predict t he effect of ascites treatment and that responders to sodium restricti on or potassium canrenoate may be in the state of vascular overflow, w hile non-responders to potassium canrenoate may be in the state of vas cular underfilling. In summary, this stepped care treatment is safe wi thout any side effects, although the diuretics themselves may lead to relative vascular underfilling.