Lupus Nephritis Ascites

Table of Contents

Ascites is defined as excessive fluid built up within the peritoneal cavity. The abdominal organs and the abdomen itself are lined with membranes called the peritoneum. Between these two linings is a space referred to as the peritoneal cavity. In Lupus Nephritis, fluid can build up in the peritoneal cavity.  This is called Lupus Nephritis Ascites.

Smaller abdominal fluid amounts usually do not produce symptoms. But, larger accumulations can cause:

• rapid weight gain
• abdominal discomfort and distention
• shortness of breath and actual dyspnea, or difficulty breathing
• swollen ankles

Severe cases of ascites can result in the retention of literally gallons of liquid in the peritoneal cavity. If fluid retention is severe, the abdomen can become swollen and painful. Breathing can be affected as the fluid-filled peritoneal cavity presses upon the diaphragm, a very necessary component of respiration.

Treatments

Reclining minimizes the amount of salt the kidneys absorb, so treatment generally starts with bed rest and a low-salt diet. Urine-producing drugs (diuretics) may be prescribed if initial treatment is ineffective. The weight and urinary output of patients using diuretics is normally carefully monitored, often on a daily basis. This scrutiny involves watching for signs of:

• Hypovolemia (massive loss of blood or fluid) that can often result in drastic drops in blood pressure.
• Azotemia (abnormally high blood levels of nitrogen-bearing materials).
• Potassium imbalance that can result in cardiac arrhythmia.
• High sodium concentration. Sodium should be restricted from the diet as much as possible.

Because of the discomfort and respiratory difficulty moderate-to-severe accumulations of fluid can produce, fluid removal, or paracentesis, is often the treatment of choice. Paracentesis involves the extraction of fluid from the abdominal cavity with a needle that is usually inserted into the peritoneum under local anesthesia. This is a relatively safe and painless method of relieving fluid build-up. It is considered safer than diuretic therapy, resulting in fewer complications and requiring shorter hospital stays.

Large-volume paracentesis is also the preferred treatment for massive ascites. Diuretics are sometimes used to prevent new fluid accumulations, and the procedure may need to be repeated periodically.

In cases of ascites that do not respond appropriately to the treatments described above, a peritoneovenous shunt may be inserted. This device is equipped with a one-way valve that allows fluid from the peritoneal cavity to pass into the venous blood circulatory system. From there the fluid is eliminated by the kidneys. In cases of malignant ascites, there is a concern that the use of such a shunt could enhance the spread of the cancer. This relatively small risk must be balanced against the positive effect the shunt can have on the individual's quality of life as well as against his or her expected survival period.