Incidence and Prognosis of Different Types of Functional Renal Failure in Cirrhotic Patients With Ascites

Assessment of renal functions in patients of chronic liver disease

“…The prognosis of a patient with advanced liver disease developing FRF is poor which is in part related to the associated liver failure. 26 Compared to patients with advanced cirrhosis but without FRF, who have an 80% survival over 8 years, the 50% survival of these patients is reduced to 40 months and development of HRS further decreases the survival. 39 Earlier diagnosis and implementation of currently established beneficial therapies such as vasoconstrictors (norepinephrine, terlipressin, ornipressin, octreotide, midodrine) and volume expanders usually in the form of albumin and isotonic saline, or renal support with renal replacement therapy or ECAD with MARS, and TIPS may help to potentially reduce the severity of kidney injury and increasing survival outcomes.…”

“…Sixteen percent of patients developed infectionrelated renal failure and our data were close to the data from a prospective study by Montoliu et al on 263 cirrhotic patients with ascites, where they found that infection related renal failure affected 37 (14.1%) patients. 26 Bacterial infections account for one-third of the cases of acute renal failure in advanced liver disease and is due to the fact that the proinflammatory response in a host with cirrhosis is significantly enhanced. 30,31 The myriads of inflammatory cytokines, such as tumour necrosis factor a and interleukin 6, released by the bacteria can induce various changes in the microcirculation of many organs including the kidneys, which include development of microthrombi, endothelial dysfunction and capillary leak resulting in hypoperfusion cellular injury of the involved organ.…”

“…In a large prospective multicentric study conducted by Montoliu et al to assess the incidence of renal dysfunction in patients with cirrhosis and ascites, they found that approximately 50% of the cirrhotic patients with ascites developed some type of FRF during the follow-up period; renal failure was associated with worse prognosis. 26 Gines et al conducted a large prospective study which included 234 non-azotemic patients of cirrhosis with ascites to assess the incidence of HRS in patients of cirrhosis with ascites and found that 18% developed type 1 HRS at 1 year and 39% at 5 years. 17 Ascites an outcome of splanchnic vasodilation, PHTN and activation of various sodium conserving mechanisms in the wake of reduced circulating volume leads to stimulation of renin angiotensin aldosterone system, sympathetic nervous system and arginine vasopressin which further compromises the renal blood flow in these patients.…”

Hepatorenales Syndrom bei dekompensierter Leberzirrhose

“…So können bei etwa 20-50 % der Patienten, die wegen einer Zirrhose stationär aufgenommen werden, Zeichen einer akuten Verschlechterung der Nierenfunktion gefunden werden [4,6,29]. Mehr als die Hälfte der Patienten, die mit Aszites stationär aufgenommen werden, entwickeln zusätzlich in den folgenden 14 Monaten eine Niereninsuffizienz [43].…”

Hepatorenal syndrome and acute kidney injury

“…Amongst hospitalized patients, AKI including cases of structural renal disease and functional renal failure, has been reported to have a prevalence of 19% [1]. In a series of 263 cirrhotic patients with ascites admitted to two large tertiary centers in Barcelona for management of ascites, 27.4% of patients developed prerenal renal failure (volume-responsive functional renal failure, FRF), 14.1% developed infection-related FRF, and 7.6% developed HRS during a mean follow-up period of 41 months [4]. Interestingly, 7.6% of patients also developed renal failure due to structural renal diseases during follow-up [4].…”