A 47-year-old male who is known to have alcoholic liver
disease with established cirrhosis is admitted to your ward with worsening
ascites. He has a paracentesis and is subsequently commenced on spironolactone
200 mgs daily and furosemide 40 mgs daily. There was no evidence of
spontaneous bacterial peritonitis on the ascitic fluid samples sent to the
Over the next few days his urine output begins to
decrease and there is a rise in his serum creatinine levels to 240
μmol/L (normal range serum creatinine 60 – 110 μmol/L).
Abdominal ultrasound scan has shown normal sized kidneys and no evidence of
obstructive uropathy. Urine dipstick examination does not show proteins or
blood. You stop the diuretics, ensure that there is no salt and water
depletion and start the patient on infusions of albumin.
In addition to the above which of the
following is likely to be of benefit to the patient?