Serum-ascites albumin gradient

Serum-Ascites Albumin Gradient

Serum-ascites albumin gradient

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The serum-ascites albumin gradient (SAAG) is a calculation used in medicine to help determine the cause of ascites. The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate.

The formula is as follows:
SAAG = (albumin concentration of serum) - (albumin concentration of ascitic fluid).

Ideally, the two values should be measured at the same time.


High gradient

A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension with 97% accuracy. This is due to increased hydrostatic pressure within the blood vessels of the hepatic portal system, which in turn forces water out into the peritoneal cavity but leaves proteins such as albumin within the vasculature.

Important causes of high SAAG ascites (> 1.1 g/dL) include:

Low gradient

A low gradient (< 1.1 g/dL) indicates ascites not associated with increased portal pressure, including nephrotic syndrome, tuberculosis, and various types of cancer.


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