PPCD in cirrhotic patients, marked by increased plasma renin activity and RAAS activation after removing over 5 liters of ascitic fluid, leads to renal vasoconstriction and can be prevented with albumin infusion.
Question: Why is the risk of Post-Paracentesis Circulatory Dysfunction (PPCD) a concern in large-volume paracentesis procedures in patients with cirrhosis?
In PPCD, removing large volumes of over 5 liters of ascitic fluid triggers RAAS overactivity, leading to fluid retention and potential kidney strain and hypertension.
There is no single universally accepted set of criteria, the following framework can be useful in identifying and diagnosing PPCD PPCD Uniqcret's Criteria: First, Exclusion of Other Causes. Rule out other potential causes of the symptoms, such as cardiac events, bleeding, or infection.
Clinical Features
Laboratory Features
Additional Considerations
RAAS overactivity in PPCD
PPCD in cirrhosis, caused by removing large volumes of sodium-rich ascitic fluid, can excessively activate the RAAS system. This overactivity leads to increased aldosterone release, causing the kidneys to reabsorb more water and sodium. The resulting fluid retention can strain the kidneys, possibly leading to renal dysfunction and hypertension.
How albumin administration combats Post-Paracentesis Circulatory Dysfunction (PPCD)
Effect on Hormones
Reducing RAAS Overactivity
Effect on Vessels
Enhancing Blood Vessel Tone
Decrease Endothelial permeability
Effect on Serum osmolality
Boosting Oncotic Pressure
All of these work together and it result is
Volume Expansion and Blood Pressure Stabilization
Improving Splanchnic Circulation
Supporting Kidney Function
Miscellaneous benefits
Comments