Han S H, Reynolds T B, Fong T L
Division of Gastrointestinal and Liver Diseases, University of Southern California School of Medicine, Los Angeles, USA.
Medicine (Baltimore). 1998 Jul;77(4):233-45. doi: 10.1097/00005792-199807000-00002.
Nephrogenic ascites is an entity that manifests as refractory ascites in patients with end-stage renal disease, where portal hypertensive, infectious, and malignant processes have been excluded. Most of these patients are undergoing hemodialysis. Hypoalbuminemia may predispose these uremic patients to ascites formation. The characteristics of the ascitic fluid suggest that the pathogenesis of the ascites is an alteration in peritoneal membrane permeability or impaired resorption due to peritoneal lymphatic channel obstruction. The ascitic fluid has a high protein content, low serum-ascites albumin gradient (SAAG), and low leukocyte count. Daily hemodialysis should be the initial therapy and is successful in one-third to three-fourths of patients within 3 weeks. Continuous ambulatory peritoneal dialysis or insertion of a peritoneovenous shunt are alternative treatments. Other therapies include instillation of intraperitoneal corticosteroids and binephrectomy, which have less predictable outcomes. Renal transplantation is the definitive treatment for nephrogenic ascites. Control of ascites reverses the progressive cachexia associated with uncontrolled disease, resulting in improved quality of life and survival approaching that of end-stage renal disease patients without ascites.
肾源性腹水是终末期肾病患者中表现为难治性腹水的一种病症，其中已排除门静脉高压、感染性和恶性病变。这些患者大多正在接受血液透析。低蛋白血症可能使这些尿毒症患者易发生腹水形成。腹水的特征表明，腹水的发病机制是腹膜通透性改变或由于腹膜淋巴通道阻塞导致吸收受损。腹水蛋白含量高、血清腹水白蛋白梯度（SAAG）低且白细胞计数低。每日血液透析应作为初始治疗方法，三分之一至四分之三的患者在3周内治疗成功。持续非卧床腹膜透析或置入腹膜静脉分流术是替代治疗方法。其他治疗方法包括腹腔内注入皮质类固醇和双侧肾切除术，但其结果较难预测。肾移植是肾源性腹水的确定性治疗方法。腹水得到控制可逆转与疾病未得到控制相关的进行性恶病质，从而提高生活质量，并使生存率接近无腹水的终末期肾病患者。
