Midodrine and Octreotide in Treatment of Cirrhosis-Related Hemodynamic Complications

Karwa, Rakhi; Woodis, C. B.

doi:10.1345/aph.1l373

Cited by 29 publications

(20 citation statements)

References 22 publications

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“…In these case reports and case series, mortality was high and most deaths occurred within 1 month. In a few patients, death was avoided only with intensive measures such as terlipressin and somatostatin analogues that have been shown to facilitate mesenteric vasoconstriction and thereby reduce portal pressure [19,20]. Furthermore, as in our series, renal failure and infection were common complications, and in most of the series, the chest tubes could not be successfully removed.…”

Section: Discussionmentioning

confidence: 74%

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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Purpose Case reports and small case series have reported a high rate of complications associated with chest tube placement for hepatic hydrothorax. We describe the inhospital and 3-month outcomes of patients who have had this procedure. Methods A retrospective medical record review was performed of all patients admitted to a tertiary care center over a 10-year period with a chest tube placed for hepatic hydrothorax. Demographic data and outcomes were collected and analyzed. Results Seventeen patients were identified; 12 were taking diuretics and 8 were taking multiple diuretics at the time of admission. MELD score was 14 (range = 7-34). During hospitalization, 16 had at least 1 and 12 had more than 1 complications. The most common complications were acute kidney injury (n = 11), pneumothorax (n = 7), and empyema (n = 5). Two patients died during the index admission and four others within 3 months of that admission. Six of seven patients who received TIPS survived. Conclusions Chest tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with questionable benefit.

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Section: Discussionmentioning

confidence: 74%

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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“…Hipertansiyon, diyabet veya önceden böbrek hastalığı olması durumunda, 4 haftadan daha fazla devam eden AKI veya 3 aydır kronik böbrek hastalığı varlığı birlikte böbrek ve karaciğer naklini gerektirebilir (38,39). hepatik ensefalopati veya yüksek serum bilirübini (>5 mg/dL) olan ileri evre karaciğer hastalarında uygun değildir (29)(30)(31). HRS tip 2'li ve TIPS'e uygun olmayan dirençli asitli hastada tedavi edici parasentez yapılır.…”

Section: İlaçlar öNerilerunclassified

Cirrhosis and Renal Dysfunction

Ayar¹

2016

Turk Neph Dial Transpl

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ÖzBöbrek fonksiyon bozukluğu, sirozlu hastalarda anlamlı morbiditeye yol açar ve klinik olarak akut böbrek hasarı (AKI), kronik böbrek yetmezliği (KBY), KBY üzerine AKI olarak karşımıza çıkar. Başlıca böbrek fonksiyon bozukluğu nedenleri; prerenal azotemi, intrinsik böbrek hasarı, hepatorenal sendrom ve postrenal hastalıklardır. Tanıda serum kreatinin değeri ve kreatinin klirensi en çok kullanılan yöntemler arasındadır. Tedavide nefrotoksik ajanlardan kaçınılması, albümin infüzyonu, vazokonstrüktör ajanlar, vaptan türevleri ve albümin içeren diyaliz seçenekleri (Prometheus, MARS vb) temel tedavi yaklaşımlarıdır. Karaciğer nakli tüm hepatorenal sendromlu ve ilerlemiş karaciğer hastalığı olanlarda düşünülmelidir. İleri karaciğer yetmezliği geliştikten sonra böbrek yetmezliği üç aydan daha fazla devam edenlerde ve özel endikasyon durumlarında karaciğer ve böbrek nakli birlikte uygulanabilir. Nakil sonrası komplikasyonlar açısından hastaların yakın takibi gerekir. Bu yazıda sirotik hastalarda böbrek fonksiyon bozukluğu ile ilgili güncel bilgiler gözden geçirilmiştir.AnAHtAR sÖzcüklER: Siroz, Akut böbrek hasarı, Kronik böbrek yetmezliği, Hepatorenal sendrom, Tedavi AbstRActRenal dysfunction in patients with cirrhosis causes significant morbidity, and clinically appears as acute kidney injury (AKI), chronic renal failure (CRF), and CRF on AKI. The main causes of renal dysfunction are prerenal azotemia, intrinsic renal failure, hepatorenal syndrome and postrenal disease. Serum creatinine and creatinine clearance are among the most commonly used parameters for the diagnosis. Avoidance of nephrotoxic agents, albumin infusion, vasoconstrictor agents, vaptan derivatives, and dialysis options including albumin are the basic treatment approaches. Liver transplantation should be considered in patients with advanced liver disease and all hepatorenal syndrome cases. After development of advanced liver failure, patients with continuing kidney failure over three months and special indications can be considered for combined liver and kidney transplantations. In this article, we reviewed the current information on kidney dysfunction in cirrhotic patients. kEY woRDs: Cirrhosis, Acute kidney injury, Chronic kidney disease, Hepatorenal syndrome, Treatment GİRİŞ Siroz; değişik nedenlerle oluşan parenkim hasarı, fibrozis ve nodül oluşumu ile birlikte, lobüler ve vasküler yapının bozulması ile karakterize, yaygın ve ilerleyici karaciğer hastalığıdır (1). Böbrek disfonksiyonu, son dönem karaciğer yetmezliği olanlarda sık görülen, mortalite ve morbiditeyi artıran bir komplikasyondur (2,3). Sirotik hastalarda böbrek tutulumunun derecesi morbidite ve mortaliteyi etkilemektedir (4). Biz bu derlememizde karaciğer yetmezliği ile böbrek hasarı ilişkisini, güncel tedavi ve klinik yaklaşımları gözden geçirmeyi amaçladık. PatofizyolojiKaraciğer hastalığına bağlı böbrek işlev bozukluğunda splanknik alanda vazodilatasyon oluşur. Karaciğer hastalığı ilerledikçe,

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“…[53][54][55] Vasoconstriction of the splanchnic vascular beds is used to treat HRS by increasing the effective arterial blood volume, thereby suppressing activation of the RAAS, SNS reversing compensatory renal vasoconstriction and increasing renal perfusion. 60,63 Although not approved for use in the United States, terlipressin, has been used in managing HRS. 56 Several pharmacological agents have been used in the management of HRS.…”

Section: Managementmentioning

confidence: 99%

Hepatorenal Disorders

Al‐Khafaji

Kellum

2015

Chest

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Renal dysfunction is common in patients with end-stage liver disease (ESLD); it takes on many forms from acute to chronic renal injury and may involve a variety of mechanisms. Hepatorenal syndrome (HRS) is a specific type of hepatorenal disorder (HRD) with a unique pathophysiology. HRS is characterized by splanchnic arterial vasodilatation and decreased effective intravascular volume that leads to renal vasoconstriction and decreased renal blood flow. The incidence of HRS in relation to other forms of HRD is unknown; however, it is estimated that 35% to 40% patients with ESLD and ascites eventually develop the condition. Two subtypes of HRS have been described. Type 1 HRS is rapidly progressive, whereas the renal function in type 2 HRS deteriorates slowly over weeks or months. Type 1 HRS may be precipitated by sepsis or acute alcoholic hepatitis and occasionally develops in patients who already have type 2 HRS. The diagnosis of HRS is based on the exclusion of other causes of renal dysfunction because no specific test is available. The definitive treatment of HRS is liver transplant. As a bridge to liver transplant, medical management with volume expansion and the use of vasoconstrictors is often implemented. A transjugular intrahepatic portosystemic shunt has been attempted in treating HRS, although there is little evidence of its efficacy compared with standard therapy. Renal replacement therapy is often used if the patient is a liver transplant candidate. Artificial liver assist devices are in the research phase.

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Midodrine and Octreotide in Treatment of Cirrhosis-Related Hemodynamic Complications

Cited by 29 publications

References 22 publications

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Cirrhosis and Renal Dysfunction

Hepatorenal Disorders

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