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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. |
