Renal Dysfunction in Chronic Liver Disease

Slack, Andy; Yeoman, Andrew D.; Wendon, Julia

doi:10.1007/978-3-642-10286-8_33

Cited by 33 publications

(41 citation statements)

References 52 publications

(60 reference statements)

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“…As mentioned, HRS is potentially reversible following liver transplantation, so a renal transplant is inappropriate for most of these patients unless they have required renal replacement therapy for over 8 weeks. 1,16,20,23 Transjugular intrahepatic portosystemic shunt Non-pharmacological intervention such as a transjugular intrahepatic portosystemic shunt (TIPS) has its use in patients with portal hypertension, as in the treatment of variceal haemorrhage and refractory ascites, but its role in the treatment of renal failure in the context of liver disease is limited. In small studies, TIPS has been beneficial in some carefully selected patients, particularly as a bridge to liver transplantation or to delay the need to initiate dialysis or filtration.…”

Section: Dialysis and Continuous Renal Replacement Therapymentioning

confidence: 99%

Liver disease and renal dysfunction

O'Riordan

2015

Medicine

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Section: Dialysis and Continuous Renal Replacement Therapymentioning

confidence: 99%

Liver disease and renal dysfunction

O'Riordan

2015

Medicine

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“…Dieser Tatsache wird im MELD-Score zur Prädiktion der kurzfristigen Prognose bei Zirrhosepatienten durch die Berücksichtigung des Serumkreatinins zusammen mit dem Serumbilirubin und der INR Rechnung getragen. Nierenfunktionsstörungen bei Patienten mit Leberzirrhose ergeben sich aus 3 Hauptursachen: prärenales Nierenversagen, renales Nierenversagen im Sinne der akuten Tubulusnekrose und HRS [41,48].…”

Section: Niereninsuffizienzunclassified

“…Die Vasodilatation initiiert die Sekretion von Vasokonstriktoren (u. a. Renin-Angiotensin-Aldosteron-System, sympathisches Nervensystem, antidiuretisches Hormon), welche den renalen Blutfluss verringern [41,48]. Hierdurch steigt die Anfälligkeit für andere Risikofaktoren, wie die Verabreichung von nichtsteroidalen Antiphlogistika und intravenösem Kontrastmittel, oder für eine toxische Schädigung durch Gallensalze bzw.…”

Section: Niereninsuffizienzunclassified

“…Die Nierenfunktionsstörungen werden durch Faktoren aggraviert, die mit einer Abnahme des effektiv zirkulierenden Blutvolumens einhergehen, wie beispielsweise rasche Flüssigkeitsverluste (z. B. gastrointestinale Blutungen, Diarrhoe), Sepsis und/oder SIRS-bedingte Vasodilatation sowie intensivierter Gebrauch von Diuretika und Restriktion peroraler Flüssigkeitszufuhr zur Aszitestherapie [41,48].…”

Section: Niereninsuffizienzunclassified

“…Das HRS ist eine potenziell reversible Nierenfunktionsstörung bei Patienten mit Leberzirrhose, die als Organmanifestation eines systemischen Problems, nämlich der hämodynamischen Veränderungen in der Zirrhose, gesehen werden sollte [41,48]. Ein wesentlicher pathophysiologischer Faktor ist die Vasodilatation im Splanchnikusgebiet.…”

Section: Hepatorenales Syndromunclassified

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Management of decompensated liver cirrhosis in the intensive care unit

Lerschmacher

Koch

Streetz

et al. 2013

Med Klin Intensivmed Notfmed

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Liver cirrhosis is the end-stage of long-standing chronic liver diseases. The occurrence of complications from liver cirrhosis increases the mortality risk, but the prognosis can be improved by optimal management in the intensive care unit (ICU). Defined diagnostic algorithms allow the etiology and presence of typical complications upon presentation to the ICU to be identified. Acute variceal bleeding requires endoscopic intervention, vasoactive drugs, antibiotics, supportive intensive care measures and, where necessary, urgent transjugular intrahepatic portosystemic shunt (TIPS) procedure. Spontaneous bacterial peritonitis needs to be diagnosed and immediately treated in patients with ascites. Hepatorenal syndrome should be treated by albumin and terlipressin. In case of respiratory failure, differential diagnosis should not only consider pneumonia, pulmonary embolism and cardiac failure, but also hepatic hydrothorax, portopulmonary hypertension and hepatopulmonary syndrome. The feasibility of liver transplantation should be always discussed in patients with decompensated cirrhosis. Artificial liver support devices may only serve as a bridging procedure until transplant.

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Comparing early liver graft function from heart beating and living‐donors: A pilot study aiming to identify new biomarkers of liver injury

Yang

Kluger

Goryński

et al. 2017

Biopharm & Drug Disp

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The liver and kidney functions of recipients of liver transplantation (LT) surgery with heart beating (HBD, n = 13) or living donors (LD, n = 9) with different cold ischemia times were examined during the neohepatic phase for the elimination of rocuronium bromide (ROC, cleared by liver and kidney) and tranexamic acid (TXA, cleared by kidney). Solid phase micro-extraction and LC-MS/MS was applied to determine the plasma concentrations of ROC and TXA, and creatinine was determined by standard laboratory methods. Metabolomics and the relative expressions of miR-122, miR-148a and γ-glutamyltranspeptidase (GGT), liver injury biomarkers, were also measured. The ROC clearance for HBD was significantly lower than that for LD (0.147 ± 0.052 vs. 0.265 ± 0.148 ml·min ·g liver) after intravenous injection (0.6 mg·kg ). The clearance of TXA, a compound cleared by glomerular filtration, given as a 1 g bolus followed by infusion (10 mg·kg ·h ), was similar between HBD and LD groups (~ 1 ml·min ·kg ). The TXA clearance in both groups was lower than the GFR, showing a small extent of hepatorenal coupling. The miR-122 and miR-148a expressions were similar for the HBD and LD groups, whereas GGT expression was significantly increased for HBD. The lower ROC clearance and the higher GGT levels in the HBD group of longer cold ischemia times performed worse than the LD group during the neophase. Metabololmics further showed clusters of bile acids, phospholipids and lipid ω-oxidation products for the LD and HBD groups. In conclusion, ROC CL and GGT expression, and metabolomics could serve as sensitive indices of early graft function. Copyright © 2017 John Wiley & Sons, Ltd.

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Renal Dysfunction in Chronic Liver Disease

Cited by 33 publications

References 52 publications

Liver disease and renal dysfunction

Liver disease and renal dysfunction

Management of decompensated liver cirrhosis in the intensive care unit

Comparing early liver graft function from heart beating and living‐donors: A pilot study aiming to identify new biomarkers of liver injury

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