Diuretics, drugs that remove excess fluid from the body, do not cause liver disease. People with liver disease often take diuretics to treat complications of the disorder. Diuretics can improve or, in some cases, worsen the symptoms and complications of liver disease. Take diuretics only in the quantity prescribed by your doctor and under his supervision if you have liver disease.
Liver Disease and the Kidneys
Diuretics put extra stress of the kidneys and also reduce the circulating blood volume by removing fluid. Liver disease also stresses the kidneys because it causes reduction in circulating blood volume as well. Low blood flow to the kidney coupled with constriction of blood vessels within the kidney result in not enough nutrients reaching the kidney, which leads to kidney failure. As fluid shifts from the blood vessels into the abdomen due to a decrease of certain proteins by the liver, blood flow to the kidneys decreases further.
Liver Disease and Fluid Retention
People with severe liver disease often retain fluid in the abdomen and lower extremities, a condition known as ascites. Diuretics, which act in one of several different ways, can help eliminate the fluid. The inability to eliminate sodium is one of the earliest symptoms of kidney damage in people with liver disease, According to an article in the April-June 2002 issue of "Annals of Hepatology," thiazide diuretics reduce the sodium content in the body, which pulls fluid with it. Potassium-sparing diuretics conserve potassium, a vital mineral often lost in diuresis, or fluid loss. Loop diuretics act on the kidneys to reduce fluid absorption. Diuretics require carefully monitoring in liver disease, because they can worsen kidney function, which often declines in liver disease.
Treating and Monitoring
Liver disease often requires a combination of diuretics, with spironolactone, a potassium-sparing diuretic and furosemide, the most common initial combination, according to the University of Washington. Frequent monitoring of kidney function blood tests and electrolyte levels helps prevent further kidney function deterioration. A rise in creatinine levels above 1.5 mg/dl indicates hepatorenal failure.
Considerations
Diuretics do not cause kidney disease and often play an important part in the treatment of complications of the disease. Diuretics can exacerbate kidney disease if it develops. Finding the balance between benefit and risk of diuretics if you have liver disease requires close physician monitoring and often frequent medication adjustments. Never adjust your diuretic doses on your own without your physician's approval.
References
- University of Washington: Hepatitis Web Study
- "American Family Physicians"; Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment; Joel Heidelbaugh, M.D., et al.; September 2006
- "Annals of Hepatology"; Pathophysiology, Diagnosis and Treatment of Ascites in Cirrhosis; Vincente Arroyo, M.D.; April-June 2002
