Renal Insufficiency in the Patient with Chronic Liver Disease

Bozanich, Nadia; Kwo, Paul Y.

doi:10.1016/j.cld.2014.09.003

Cited by 16 publications

(11 citation statements)

References 78 publications

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“…1C). In addition, serum sodium concentrations were lowered significantly (see below), which is very often associated with chronic liver diseases 4 . We furthermore raised data from transcriptomic analysis of samples after liver resection in the absence and presence of BM-MSCs.…”

Section: Resultsmentioning

confidence: 99%

“…This causes haemodynamic turbulences followed by reduced lung, heart and kidney perfusion, the latter eventually provoking acute kidney injury (AKI) 3 . A similar mechanism applies to the development of the hepatorenal syndrome in acute-on-chronic liver failure, which has led to the concept of classifying renal failure associated with cirrhosis within the framework of the acute kidney injury network 4–6 .…”

Section: Introductionmentioning

confidence: 99%

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Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model

Tautenhahn

Brückner

Uder

et al. 2017

Sci Rep

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In patients, acute kidney injury (AKI) is often due to haemodynamic impairment associated with hepatic decompensation following extended liver surgery. Mesenchymal stem cells (MSCs) supported tissue protection in a variety of acute and chronic diseases, and might hence ameliorate AKI induced by extended liver resection. Here, 70% liver resection was performed in male pigs. MSCs were infused through a central venous catheter and haemodynamic parameters as well as markers of acute kidney damage were monitored under intensive care conditions for 24 h post-surgery. Cytokine profiles were established to anticipate the MSCs’ potential mode of action. After extended liver resection, hyperdynamic circulation, associated with hyponatraemia, hyperkalaemia, an increase in serum aldosterone and low urine production developed. These signs of hepatorenal dysfunction and haemodynamic impairment were corrected by MSC treatment. MSCs elevated PDGF levels in the serum, possibly contributing to circulatory homeostasis. Another 14 cytokines were increased in the kidney, most of which are known to support tissue regeneration. In conclusion, MSCs supported kidney and liver function after extended liver resection. They probably acted through paracrine mechanisms improving haemodynamics and tissue homeostasis. They might thus provide a promising strategy to prevent acute kidney injury in the context of post-surgery acute liver failure.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model

Tautenhahn

Brückner

Uder

et al. 2017

Sci Rep

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“…As in noncirrhotic patients, AKI occurs from prerenal, renal and postrenal causes. The most common etiologies of AKI this cirrhotic population, which account for 80% to 90% of all cases, include volume depletion, acute tubular necrosis (ATN), and hepatorenal syndrome (HRS) …”

Section: Renal Dysfunction In Hepatitis B Cirrhosismentioning

confidence: 99%

“…No modification of drug doses in decompensated cirrhosis with AKI will lead to increase chances of progressive renal insufficiency. Although maintaining euvolemia is important, especially in ATN, excessive intravenous fluid administration in renal failure in the setting of cirrhosis may lead to fluid overload and increased hyponatraemia, ascites and/or oedema because of the solute‐free water retention . Infections or bleeding should be treated urgently.…”

Section: Renal Dysfunction In Hepatitis B Cirrhosismentioning

confidence: 99%

Spectrum of hepatitis B and renal involvement

Shah

Amarapurkar

2017

Liver International

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“…However, the water excretion ability is preserved in mild-to-moderate renal disease, and a near to normal serum sodium concentration is usually maintained if water intake is not excessive [58]. Hyponatremia related to the impairment of renal function is often observed in liver diseases [59]. For example, a study showed that 56 % of patients with acute renal failure due to cholangiocarcinomainduced obstructive jaundice exhibited hyponatremia.…”

Section: Hyponatremia Due To Endocrine Disorders In Liver Disease Patmentioning

confidence: 99%

Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

et al. 2016

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Hyponatremia (Na(+) <135 mmol/l) is the most common electrolyte disorder. Cirrhosis represents a rather frequent cause of hyponatremia mainly due to systemic and splanchnic vasodilation resulting in decreased effective arterial blood volume, which leads to excessive non-osmotic secretion of antidiuretic hormone. However, hyponatremia of multifactorial origin may be seen in patients with liver diseases. The review focuses on the factors and pathogenetic mechanisms of decreased sodium levels other than the hemodynamic compromise of cirrhosis in patients with liver diseases. The mechanisms and causal or contributing role of pseudohyponatremia, hyperglycemia, infections, drugs and toxins as well as of endocrine disorders, renal failure and cardiac disease in patients with liver disease are meticulously discussed. Hyponatremia of multifactorial origin is frequently observed in patients with liver diseases, and special efforts should be made to delineate the underlying causative and precipitating factors as well as the risk factors of the osmotic demyelination syndrome in order to properly manage this serious electrolyte disorder and avoid treatment pitfalls.

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Renal Insufficiency in the Patient with Chronic Liver Disease

Cited by 16 publications

References 78 publications

Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model

Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model

Spectrum of hepatitis B and renal involvement

Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

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