Pathophysiological basis of pharmacotherapy in the hepatorenal syndrome

Möller, Sören; Bendtsen, Flemming; Henriksen, Jens H.

doi:10.1080/00365520510012064

Cited by 26 publications

(9 citation statements)

References 95 publications

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“…Rationale: The most effective method for treatment of type-1 HRS currently available is the administration of systemic vasoconstrictor drugs (Table 6) in order to reduce the marked vasodilatation in the splanchnic and systemic circulations thereby improving the associated impaired circulatory function [58,59]. Although randomized controlled trials [60-77] and meta-analysis [78,79] of the combination of terlipressin and albumin have been shown to reverse HRS type 1 and improve renal function in patients with type-1 HRS (Figure 2), data regarding survival benefit has been limited although it may allow survival to transplantation (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

et al. 2012

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IntroductionRenal dysfunction is a common complication in patients with end-stage cirrhosis. Since the original publication of the definition and diagnostic criteria for the hepatorenal syndrome (HRS), there have been major advances in our understanding of its pathogenesis. The prognosis of patients with cirrhosis who develop HRS remains poor, with a median survival without liver transplantation of less than six months. However, a number of pharmacological and other therapeutic strategies have now become available which offer the ability to prevent or treat renal dysfunction more effectively in this setting. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies.MethodsWe undertook a systematic review of the literature using Medline, PubMed and Web of Science, data provided by the Scientific Registry of Transplant Recipients and the bibliographies of key reviews. We determined a list of key questions and convened a two-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research.ResultsOf the 30 questions considered, we found inadequate evidence for the majority of questions and our recommendations were mainly based on expert opinion. There was insufficient evidence to grade three questions, but we were able to develop a consensus definition for acute kidney injury in patients with cirrhosis and provide consensus recommendations for future investigations to address key areas of uncertainty.ConclusionsDespite a paucity of sufficiently powered prospectively randomized trials, we were able to establish an evidence-based appraisal of this field and develop a set of consensus recommendations to standardize care and direct further research for patients with cirrhosis and renal dysfunction.

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Section: Resultsmentioning

confidence: 99%

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

et al. 2012

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“…As cirrhosis progresses these hemodynamic changes worsen and the cardiac output cannot compensate anymore, resulting in effective central hypovolemia. Endogenious vasoconstrictors are activated then, resulting in renal vasoconstriction, sodium and water retention (8). Decrease in renal perfusion causes decrease in glomerular filtration rate and sodium excretion.…”

Section: Pathogenesis Of Kidney Dysfuncti̇on In Liver Cirrhosismentioning

confidence: 99%

Renal dysfunctions in cirrhosis

2016

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Kidney dysfunction is a common and potentially life-threating event in patients with cirrhosis, and underlying mechanisms for renal dysfunction are quite variable. Acute kidney injury (AKI) is relatively frequent encountered in approximately 20% of hospitalized patients with cirrhosis. Nevertheless, chronic kidney disease (CKD) occurs in almost 1% of all patients with cirrhosis. In this review various renal problems encountered in cirrhotic patients are discussed and strategies to prevent renal dysfunction are suggested.

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“…Avid Na + and water retention are very common in cirrhosis and may lead to ascites, a common complication of this disease and a major cause of morbidity and mortality, with the occurrence of spontaneous bacterial peritonitis, variceal bleeding, and development of the hepatorenal syndrome [40][41][42]. In CHF and cirrhosis with ascites, the primary disturbance leading to Na + retention does not originate within the kidney, but from extrarenal mechanisms that regulate renal Na + and water handling.…”

Section: Hepatorenal Syndromementioning

confidence: 99%

Deleterious Effects of Increased Intra-Abdominal Pressure on Kidney Function

Armaly

Abassi

2014

Advances in Nephrology

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Elevated intra-abdominal pressure (IAP) occurs in many clinical settings, including sepsis, severe acute pancreatitis, acute decompensated heart failure, hepatorenal syndrome, resuscitation with large volume, mechanical ventilation with high intrathoracic pressure, major burns, and acidosis. Although increased IAP affects several vital organs, the kidney is very susceptible to the adverse effects of elevated IAP. Kidney dysfunction is among the earliest physiological consequences of increased IAP. In the last two decades, laparoscopic surgery is rapidly replacing the open approach in many areas of surgery. Although it is superior at many aspects, laparoscopic surgery involves elevation of IAP, due to abdominal insufflation with carbonic dioxide (pneumoperitoneum). The latter has been shown to cause several deleterious effects where the most recognized one is impairment of kidney function as expressed by oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF). Despite much research in this field, the systemic physiologic consequences of elevated IAP of various etiologies and the mechanisms underlying its adverse effects on kidney excretory function and renal hemodynamics are not fully understood. The current review summarizes the reported adverse renal effects of increased IAP in edematous clinical settings and during laparoscopic surgery. In addition, it provides new insights into potential mechanisms underlying this phenomenon and therapeutic approaches to encounter renal complications of elevated IAP.

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Pathophysiological basis of pharmacotherapy in the hepatorenal syndrome

Cited by 26 publications

References 95 publications

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

Renal dysfunctions in cirrhosis

Deleterious Effects of Increased Intra-Abdominal Pressure on Kidney Function

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