Improvement in renal function in hepatorenal syndrome with N-acetylcysteine

Holt, Stephen G; Goodier, David; Marley, Richard; Patch, David; Burroughs, Andrew K.; Fernando, Bimbi; Moore, Kevin

doi:10.1016/s0140-6736(05)74933-3

Cited by 159 publications

(85 citation statements)

References 3 publications

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“…Hence, both the circulatory and immune dysfunction are responsible for renal injury in these patients. This has been demonstrated by various studies in the past [58,[81][82][83][84][85][86].…”

Section: Renal Failurementioning

confidence: 66%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Section: Renal Failurementioning

confidence: 66%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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“…In a recent study, 12 patients received continuous infusion of N-acetylcysteine, an antioxidant, for 5 days. Creatinine clearance improved from 24 Ϯ 3 mL/min to 43 Ϯ 4 mL/min without any change in liver function or systemic hemodynamics, 60 suggesting that it was the reduction in oxidant stress per se that caused the improvement in renal function. Again, these are preliminary data and they need to be confirmed by clinical controlled trials.…”

Section: Antioxidantsmentioning

confidence: 98%

New challenge of hepatorenal syndrome: Prevention and treatment

Wong¹

2001

Hepatology

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Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in hepatology today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal hemodynamics worsens, and renal failure occurs. Renal failure was shown 15 years ago to be potentially reversible after liver transplantation. This potential reversibility together with increased understanding of the pathogenesis has led to successful preliminary attempts to reverse HRS nonsurgically with combinations of splanchnic vasoconstrictors and colloid volume expansion, insertion of transjugular intrahepatic portovenous shunt radiologically, and improved forms of dialysis. Recent classification of HRS into the acute onset or severe type 1 with virtually 100% mortality and the more insiduous less severe type II promises to shed more light on the pathogenesis of HRS, especially on the currently unrecognized precipitating factors. It is hoped that this classification will be included in the necessary and carefully performed clinical trials, which should lead to clearer indications for the available therapies. The challenge now is to use all this information to improve our management of cirrhotic patients to prevent occurrence of HRS in the future. (HEPATOLOGY 2001;34:1242-1251.)Progressive oliguric renal failure is a common and severe complication in patients with advanced liver disease. In a large prospective follow-up study of cirrhotic patients with ascites, development of renal failure occurred in 18% and 39% of the patients at 1 year and at 5 years, respectively, with a median survival of 1.7 weeks or a 90% mortality at 10 weeks. 1 Hepatorenal syndrome (HRS) originally referred to occurrence of renal failure following biliary surgery. 2 The definitions of HRS gradually evolved to describe the renal failure observed in patients with liver failure associated with low urinary sodium levels and absence of renal pathology. 3 A recent consensus conference further defined HRS as types I and II with the following diagnostic criteria: type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 2.5 mg/dL or a halving of the creatinine clearance to less than 20 mL/min in less than 2 weeks; type II HRS is a more chronic form with a slowly progressive increase in serum creatinine level to greater than 1.5 mg/dL or a creatinine clearance of less than 40 mL/min 4 and has a corresponding better prognosis. Until recently, liver transplantation was the only definitive treatment for HRS. 5,6 However, even then, the reported survival rates of these HRS patients posttransplantation have been less than in transplanted patients with normal renal function, and the return of renal function to normal may be delayed for months or years. 7,8 Furthermore, liver transplanta...

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“…77 The role of inflammation and/or oxidative stress in renal failure associated with ACLF is highlighted by the benefit of antiinflammatory agents such as albumin, pentoxifylline or N-acetylcyteine, which decreased the risk of renal dysfunction in patients with alcoholic hepatitis. 80,81 In ACLF, both prerenal and renal causes are involved in the pathogenesis of acute renal failure. Prerenal factors are generally associated with renal hypoperfusion, which may be associated with intravascular volume depletion (haemorrhage, renal and gastro-intestinal fluid loss).…”

Section: Livermentioning

confidence: 99%