[Ascites, spontaneous bacterial peritonitis and hepatorenal syndrome - Complications of circulatory failure in cirrhosis].

Ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome-acute kidney injury (HRS-AKI) are frequent and clinically significant complications in patients with cirrhosis, each conferring a substantial increase in mortality risk. Their pathogenesis is fundamentally driven by the development of splanchnic and systemic vasodilation secondary to portal hypertension, compounded by intestinal bacterial translocation. The diagnosis of ascites and SBP should be established without delay, employing a combination of laboratory testing and imaging modalities. In contrast, the diagnosis of HRS-AKI relies on the presence of cirrhosis with ascites together with the exclusion of alternative, more common causes of kidney injury. Management strategies vary by complication: ascites is typically addressed with diuretic therapy and placement of a transjugular intrahepatic portosystemic shunt (TIPS); SBP requires prompt initiation of antibiotic therapy combined with albumin administration; and HRS-AKI is treated with vasoconstrictor agents in conjunction with albumin.