Management of Renal Complications of Liver Disease

Abstract

Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive. Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.

Renal resistive indexes and some renal functions in liver cirrhotic children

“…Impaired renal perfusion plays a key role in sodium and fluid retention and severe renal vasoconstriction leads to the development of hepatorenal syndrome 1,2,4 . In the present study, sodium excretion was found to be decreased in decompensated cirrhotic patients, especially in ascitic patients.…”

“…The RRI were correlated with the severity of hepatocellular dysfunction, assessed by C‐P score. The RRI, study by means of Doppler USG, showed progressively increased concentrations with the evolution of the liver disease, probably with deterioration of the renal vascular hemodynamics and with the activation of endogenous compensatory mechanisms due to decrease of the effective plasma volume 1 . Numerous adult studies showed that kidney dysfunction characterized by early renal hemodynamic changes before clinically recognized kidney disease might commonly develop in patients with established liver disease.…”

“…Progressive kidney dysfunction is generally considered to be functional in nature because the consistent pathologic changes are absent. The hallmark change is intense intrarenal vasoconstriction associated with reduced effective renal plasma flow and an elevated renal arterial vascular resistance originating from the hyperdynamic circulation 1−6 . Invasive methods have demonstrated that intrarenal blood flow is already reduced in the non‐ascitic phase of the disease and progressively decreases with disease evolution 5,6 .…”

“…Liver diseases are frequently accompanied by a variety of alterations in renal function and electrolyte metabolism resulting in several complications. With the progress of chronic liver disease, renal prognostic differences including renal sodium and water handling, concentration defects, hepatorenal syndrome and acute renal failure might develop 1−6 . Patients with cirrhosis have decreased hepatic blood flow, hypoalbuminemia, imbalance of starling forces in splanchnic bed and decreased total peripheral resistance.…”