Hepatorenal Syndrome

Wadei, Hani M.; Martin, L.; Ahsan, Nasimul; Gonwa, Thomas A.

doi:10.2215/cjn.01340406

Cited by 228 publications

(219 citation statements)

References 141 publications

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“…Two subtypes of HRS have been identified: type 1 HRS is a rapidly progressive renal failure that is defined by doubling of the initial Scr to a level over 2.5 mg/dL or by a 50% reduction in creatinine clearance to a level Ͻ20 mL/min in less than 2 weeks, and type 2 did not meet these criteria of progression. 6 There were 6 type 1 HRS patients and 2 type 2 HRS patients among the 8 HRS patients in this study. The retrieved data included the the following: duration of HRS from the time the patients met the diagnostic criteria to the time of transplantation (in days); the need for preoperative renal replacement therapy; a history of diabetes mellitus and hypertension; the cause of liver failure; and preoperative laboratory data, including liver function tests, blood urea nitrogen, as well as Scr.…”

Section: Methodsmentioning

confidence: 57%

“…HRS is characterized by a marked reduction in GFR and renal plasma flow in the absence of other causes of renal failure. 6 Therefore, HRS can be improved transiently by the administration of vasoconstrictors and albumin, or by placement of a transjugular intrahepatic portosystemic stent-shunt (TIPS). OLT remains the treatment of choice for these patients because it effects a cure of both the liver disease and the associated renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…The hallmark of HRS is intense renal vasoconstriction with predominant peripheral arterial vasodilatation associated with portal hypertension. 6 Although the treatment of HRS seeks to expand the central blood volume by simultaneously increasing the total plasma volume and reducing intense peripheral vasodilatation, the effects are limited with the exception of OLT, 4 which cures both the diseased liver and the renal dysfunction. 6 Although HRS is a reversible functional renal impairment, there is a variable rate of complete renal functional recovery after OLT.…”

mentioning

confidence: 99%

“…6 Although the treatment of HRS seeks to expand the central blood volume by simultaneously increasing the total plasma volume and reducing intense peripheral vasodilatation, the effects are limited with the exception of OLT, 4 which cures both the diseased liver and the renal dysfunction. 6 Although HRS is a reversible functional renal impairment, there is a variable rate of complete renal functional recovery after OLT. 5 Furthermore, much of the existing information on outcome in patients with HRS is derived from studies performed years ago; a recent study estimated the posttransplantation reversal of HRS to be only 58%.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Does Hepatorenal Syndrome Affect the Result of Liver Transplantation? Clinical Observations

Park¹,

Moon²,

Hwang³

et al. 2010

Transplantation Proceedings

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Section: Methodsmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Does Hepatorenal Syndrome Affect the Result of Liver Transplantation? Clinical Observations

Park¹,

Moon²,

Hwang³

et al. 2010

Transplantation Proceedings

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“…Until 2006, HRS definitions had referred to a reversible damage of renal function occurring in patients with advanced liver cirrhosis or fulminant liver failure and is marked by decrease in glomerular filtration rate and renal plasma flow, in the absence of other causes of renal dysfunction [7]. With the advancement of knowledge, it was proven that the original definition lacked concision regarding numerous exclusion criteria, among them sepsis [8].…”

Section: Introductionmentioning

confidence: 99%

Hepatic and Renal Features in Sepsis: Etiological, Clinical and Laboratory Correlations

Bejan¹

2017

MOJCR

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Hepatorenal syndrome (HRS) occurring in sepsis has become an accepted approach since 2007, type I HRS being especially characteristic to alterations occurring in sepsis. This study aimed to find associations between elements pertaining to the microbiological, clinical and biochemical aspects in patients with hepatic and/ or renal dysfunctions and HRS in sepsis. A total of 117 patients with sepsis were included in the study, patients that had been admitted in the Infectious Disease Clinical Hospital in Iasi, Romania, across a period of 17 months, from November 2012 to April 2014, presenting with or developing hepatic or renal functional disorders, HRS, and other organ dysfunctions. We have carried out a statistical analysis of paraclinical parameters in the context of clinical modifications.Thus, we have identified a series of statistical correlations between the levels of serum creatinine and the degree of severity in sepsis, and also between total bilirubin level and altered neurological status (coma, confusional state). Using the ROC curve analysis, the optimal cut-off values for ALT, AST and total bilirubin were set at 78 IU/L, 75.5 IU/L, and 25.5 mg%, respectively, while the Quick Index showed a cut-off value of 66%, in an inversely proportion relationship with unfavourable evolution of liver disease.

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Pre-operative biliary drainage for obstructive jaundice

Yuan

Gurusamy

Wang

et al. 2012

Cochrane Database of Systematic Reviews

127

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Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60% and 100%. There was no significant difference in mortality (40/265, weighted proportion 14.9%) in the pre-operative biliary drainage group versus the direct surgery group (34/255, 13.3%) (RR 1.12; 95% CI 0.73 to 1.71; P = 0.60). The overall serious morbidity was higher in the pre-operative biliary drainage group (60 per 100 patients in the pre-operative biliary drainage group versus 26 per 100 patients in the direct surgery group) (RaR 1.66; 95% CI 1.28 to 2.16; P = 0.0002). The proportion of patients who developed serious morbidity was significantly higher in the pre-operative biliary drainage group (75/102, 73.5%) in the pre-operative biliary drainage group versus the direct surgery group (37/94, 37.4%) (P < 0.001). Quality of life was not reported in any of the trials. There was no significant difference in the length of hospital stay (2 trials, 271 patients; MD 4.87 days; 95% CI −1.28 to 11.02; P = 0.12) between the two groups. Trial sequential analysis showed that for mortality only a small proportion of the required information size had b...

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Hepatorenal Syndrome

Cited by 228 publications

References 141 publications

Does Hepatorenal Syndrome Affect the Result of Liver Transplantation? Clinical Observations

Does Hepatorenal Syndrome Affect the Result of Liver Transplantation? Clinical Observations

Hepatic and Renal Features in Sepsis: Etiological, Clinical and Laboratory Correlations

Pre-operative biliary drainage for obstructive jaundice

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