Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites

Ginés, Àngels; Escorsell, Àngels; Ginès, Pere; Saló, Joan; Jiménez, Wladimiro; Inglada, Luís; Navasa, Miquel; Clària, Joan; Rimola, Antoni; Arroyo, Vicente; Rodés, Joan

doi:10.1016/0016-5085(93)90031-7

Cited by 794 publications

(592 citation statements)

References 24 publications

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“…80 Therefore, in advanced cirrhosis, prevention of HRS is a clinical priority. Strategies should focus on directed treatment of precipitants, such as rapid restoration of effective circulation volume with albumin, hemodynamic support with vasoactive therapy as indicated, antimicrobials and albumin for spontaneous bacterial peritonitis, 81 and strict avoidance of nephrotoxins, i.e., contrast media.…”

Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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“…Less than half of those who develop spontaneous bacterial peritonitis can be expected to survive a year, whereas the median survival among patients with hepatorenal syndrome is less than 2 weeks. 132,133 Prognostic tools in FHF. The prognosis of individual patients with FHF varies widely.…”

Section: Prognostic Tools In Acute and Chronic Liver Diseasementioning

confidence: 99%

Liver transplantation

Carithers

2000

Liver Transpl

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Liver transplantation has revolutionized the care of patients with end-stage liver disease. Liver transplantation is indicated for acute or chronic liver failure from any cause. Because there are no randomized controlled trials of liver transplantation versus no therapy, the efficacy of this surgery is best assessed by carefully comparing postoperative survival with the known natural history of the disease in question. The best examples of this are in primary biliary cirrhosis and primary sclerosing cholangitis, for which well-validated disease-specific models of natural history are available. There are currently relatively few absolute contraindications to liver transplantation. These include severe cardiopulmonary disease, uncontrolled systemic infection, extrahepatic malignancy, severe psychiatric or neurological disorders, and absence of a viable splanchnic venous inflow system. One of the most frequently encountered contraindications to transplantation is ongoing destructive behavior caused by drug and alcohol addiction. The timing of the surgery can have a profound impact on the mortality and morbidity of patients undergoing liver transplantation. Because of the long waiting lists for donor organs, the need to project far in advance when transplantation might be required has proven to be one of the greatest challenges to those treating patients with end-stage liver disease. Three important questions must be addressed in a patient being considered for liver transplantation: (1) when should the patient be referred for possible transplantation? (2) when should the patient be listed for transplantation? and (3) when is the patient too sick to have a reasonable chance of surviving the perioperative period?

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“…1,2 The main pathophysiologic basis for the progression from cirrhosis with diuretic-sensitive ascites to diuretic-refractory ascites and eventually to HRS is progressive systemic arterial vasodilation. 3 Arterial vasodilation leads to a decrease in effective arterial blood volume, which in turn activates renal sodium-retentive mechanisms and leads to renal vasoconstriction.…”

mentioning

confidence: 99%