Furosemide-Induced Natriuresis As A Rapid Test for early identification of Cirrhotic patients with refractory Ascites

Our study was conducted on 60 patients who further divided into responsive (30 patients) and refractory ascites (30 patients) aiming at evaluation of a rapid and simple test to diagnoserefractory ascites, a critical disease entity that carries a poor prognosis and need liver transplantation. All patients were subjected to thorough clinical, radiological and laboratoryinvestigations, involving CBC, liver and renal function tests, detection of serum sodium and Aldosterone levels, analysis of the ascetic fluid and 24-hours urinary sodium excretion (one day before the test).An intravenous injection of 80 mg furosemide was done in patients of both groups after withdrawn of diuretics for 3 days and maintenance on low sodium diet (80 mEq/day). The 8-hours urinary sodium excretion was significantly high with a cut-off value of 75 mEq in patients with responsive ascites in comparison with the low level with cut-off value of 55 mEq in patients with refractory ascites.This test enables patients to be listed for transplantation earlier, which is critical because the waiting time is increasing due to a shortage of liver donors. The test is also of obvious interest tocorrectly identify patients as diuretic responders even if they were referred to the liver unit for ascites presumably refractory to medical treatment. Such patients can be controlled just by dietetic education and diuretic dosage adjustment, thus avoiding unnecessary invasive procedures