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Normally, the amount of sodium excreted by our kidneys is equal to our sodium intake (and adjusted for other factors, such as sodium loss in sweat) so that we remain in overall sodium balance. Yet, in some conditions, such as excess fluid in the abdomen with liver disease (ascites) the kidneys retain sodium, leading to a positive sodium balance. Because sodium and water usually move together, this excess sodium retention may worsen the ascites. The reasons for this retention are unclear and there is a "chicken-or-egg" debate: does the ascites develop first, because of a leak from the fluid inside our blood vessels? Then the sodium retention is the physiological response by the kidneys to restore normal blood volume. Or is the sodium retention first, leading to excess blood fluid, which then leaks into the abdomen? The question is clinically relevant as it affects the treatment of ascites. A new research paper now provides evidence for a primary sodium retention, caused directly by the liver disease, which then facilitates the development of ascites.

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This page is a summary of: Ascites: Under- and Overfill, Journal of the American Society of Nephrology, September 2024, Wolters Kluwer Health,
DOI: 10.1681/asn.0000000000000493.
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