From the Guidelines
Anasarca is primarily caused by severe heart failure, advanced kidney disease, severe liver disease, and protein-losing conditions, which disrupt fluid balance and lead to excessive fluid accumulation in tissues and body cavities. The causes of anasarca can be understood by considering the mechanisms that lead to fluid imbalance in the body. According to the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 1, symptoms and signs of heart failure, such as peripheral oedema, result from sodium and water retention. Some key causes of anasarca include:
- Severe heart failure, where the heart cannot effectively pump blood, leading to fluid backup in tissues
- Advanced kidney disease or nephrotic syndrome, which reduces the kidneys' ability to filter fluid and protein, allowing fluid to leak into tissues
- Severe liver disease, particularly cirrhosis, which decreases albumin production and increases portal hypertension
- Protein-losing conditions like malnutrition or protein-losing enteropathy, which reduce oncotic pressure that normally keeps fluid in blood vessels
- Certain medications, lymphatic system blockages, and severe allergic reactions can also trigger anasarca The underlying mechanism involves increased hydrostatic pressure, decreased oncotic pressure, or increased capillary permeability, all of which disrupt the normal balance that keeps fluid within blood vessels, as noted in the context of heart failure diagnosis and treatment 1.
From the Research
Anasarca Causes
- Anasarca can be caused by various factors, including beriberi heart disease and diabetic nephropathy, as seen in a 40-year-old man who presented with severe anasarca due to these conditions 2.
- Nephrotic syndrome can also lead to anasarca, as observed in a patient with cystinuria who developed nephrotic syndrome and anasarca after treatment with tiopronin 3.
- TAFRO syndrome, a systemic inflammatory disease, is another cause of anasarca, characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly 4.
Underlying Conditions
- Beriberi heart disease, caused by thiamine deficiency, can lead to high-output heart failure and anasarca 2.
- Diabetic nephropathy, a complication of diabetes mellitus, can cause nephrotic syndrome and anasarca 2.
- Cystinuria, a rare cause of kidney stones, can lead to nephrotic syndrome and anasarca when treated with tiopronin 3.
- TAFRO syndrome, a special subtype of idiopathic multicentric Castleman disease (iMCD), can cause anasarca due to its systemic inflammatory nature 4.