RENAL EFFECTS OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN CIRRHOSIS - COMPARISON OF PATIENTS WITH ASCITES, WITH REFRACTORY ASCITES,OR WITHOUT ASCITES

Penal effects of the transjugular intrahepatic portosystemic shunt (TI PS) were compared in 6 patients without ascites (group 1), 11 patients with ascites responding to diuretic treatment (group 2), and 6 patien ts with refractory ascites (group 3). Seven days after insertion of TI PS, 24-hour urinary sodium excretion had increased in patients with as cites: 113 +/- 16 mmol to 170 +/- 30 mmol (P = .012) in group 2, and 2 2 +/- 8 mmol to 77 +/- 27 mmol (P = .050) in group 3, In group 3, frac tional sodium excretion tended to increase from 0.26% +/- 0.14% to 0.6 2% +/- 18% (P = .081), The relative increase of urinary sodium excreti on (to 444% +/- 122%) and fractional sodium excretion (to 413% +/- 127 %) in group 3 was significantly (P < .05) higher than in group 1 and g roup 2, respectively. Creatinine clearance and 24-hour urinary volume were not significantly changed in either group. Patients with Child-Pu gh class C had a more pronounced effect of TIPS on urinary sodium excr etion (increase to 396% +/- 115% vs. 139% +/- 15%; P = .066) and on fr actional sodium excretion (increase to 415% +/- 103% vs. 94% +/- 15%; P = .020) than patients with less-severe liver disease. Fractional sod ium excretion of less than 0.35% before TIPS was found to be an indica tor of renal response to TIPS. The effect of TIPS on urinary sodium ex cretion and on fractional sodium excretion was related to the patients ' Child-Pugh score (r = .55; P = .007 and u = .68; P = .001, respectiv ely) and inversely to their fractional sodium excretion (r = .44; P = .047 and r = -.54; P = .012, respectively) before TIPS. These data dem onstrate that TIPS affects renal sodium handling in patients with asci tes, particularly in patients with refractory ascites, Severity of liv er disease and fractional sodium excretion before TIPS are parameters to predict the extent of the renal response.