الفهرس Only 14 pages are availabe for public view
 |  | from | 158 |  |  |
| | | from | 158 | | |
Abstract
The diagnosis of refractory ascites in cirrhotic patients carries a poor prognosis and liver transplantation should always be considered in this situation. Identification of patients who will not respond to diuretic therapy usually requires several weeks of observation during which a trial of diuretics is instituted using stepwise increases in dosage in order to classify ascites as refractory. The aim of the work in the present study is to evaluate reliability of the furosemide-induced natriuresis (FIN) test in diagnosing refractory ascites.
A case – control study was conducted in the department of hepatology and gastroenterology Kobry AL-Kobba Military Medical Compound and Department of Tropical Medicine Ain Shams University. Patients were selected and divided into two groups; control group (included 25 patients with responsive ascites) and refractory group (included 23 patients with refractory ascites).
Patients were admitted to the hospital, kept under a low sodium diet and all diuretics were withdrawn for 3 days. A 24 – hours urine collection was performed to measure the daily Na in urine (taken as baseline). A bolus dose of furosemide 80 mg was injected intravenously and urine was collected for 8 hours with measurements of urinary sodium and volume. Blood pressure was measured immediately after an hour of the injection; 24 and 48 hours later.
Results of the furosemide-induced natriuresis (FIN) test showed that the basal (i.e. 24 hour) urinary Na excretion was significantly lower in the refractory group. Eight hours after injection of furosemide, the urinary Na excretion had a mean of 37.41 mmol/L in refractory group compared to a mean of 123.5 mmol/L in control group. This difference was statistically highly significant. The diagnostic validity test showed that the sensitivity and the specificity of 8 hours urinary Na excretion was 100% at a value of 52 mmol/L. The baseline urinary Na excretion showed 96% sensitivity and 70% specificity at a value of 53 mmol/L.