Many patients with hepatorenal syndrome (HRS) end up receiving a combined liver and kidney transplant (CKLT) with preservation of native kidneys, specially type 1 HRS since is characterizes by a very rapid deterioration of renal function. Eventually, most of the patients regain renal function, but it is unknown if this is due to the transplanted kidney, the recovery of native renal function, or both. The aim of this study is to evaluate if there is recovery of native renal function in patients with HRS following CKLT. 22 patients (16 men; 6 women) with history of HRS and status post CKLT were studied. Mercapto-acetyltriglycine-3 renograms in the anterior and posterior views with the three kidneys in the field of view were simultaneously acquired. The renograms were analyzed by creating regions of interest around the transplanted and native kidneys. Relative contribution to the renal function, clearance, and effective renal plasma flow for the transplanted and native kidneys were obtained. 1/22 (4.5%) patients presented with a very poor functioning transplanted kidney, in 15/22 (68%) cases the combined native renal function was markedly poorer than the transplanted renal function and in 6/22 (27%) native kidneys showed a contribution to the renal function similar to the transplanted kidney. In conclusion, our series show that around 32% of the HRS patients recovered their native renal function after CKLT. Identification of common factors that affect recovery of native renal function may help to avoid unnecessary renal transplants, significantly reducing morbidity and cost, while facilitating a reallocation of scarce donor resources.
We describe the case of a 32-year-old healthy man who presented to the Emergency Department (ED) with vomiting, dizziness, and diaphoresis in addition to transient episodes of loss of consciousness on the day of admission. The patient's past medical history was unremarkable. Once in the ED triage vitals showed a heart rate of 254 beats per minute and an initial Electrocardiogram (EKG) showing stable monomorphic ventricular tachycardia. After conversion to sinus rhythm the patient was admitted where and after a long array of tests, the patient was diagnosed with cardiac sarcoidosis. Implantable Cardioverter-Defibrillators (ICD) was implanted and he was started on corticosteroids. The medical management of the patient's treatment with corticosteroids was very challenging. Fludeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) was the most helpful tool and the test of choice for the follow up in his medical management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.