Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A Delphi technique-based consensus

Arab, Juan Pablo; Claro, Juan Carlos; Arancibia, Juan Pablo; Contreras, Jorge; Gómez, Fernando; Muñoz, Cristián Pérez; Nazal, Leyla; Roessler, Eric; Wolff, Rodrigo; Arrese, Marco; Benítez, Carlos

doi:10.4254/wjh.v8.i25.1075

Cited by 12 publications

(14 citation statements)

References 60 publications

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“…Terlipressin and albumin administration can reverse HRS and reduce the associated short-term mortality rate[ 257 , 258 ]. Terlipressin alone is effective in reversing HRS in a smaller number of patients (40%-50%).…”

Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

“…In a recent therapeutic algorithm for HRS 1, the use of the combination of octreotide, midodrine and albumin without vasoconstrictors was discouraged because of low efficacy[ 255 ]. The use of vasopressin for the treatment of HRS-1 was also not recommended, due to several adverse effects and the lack of randomized, clinical trials supporting this use[ 257 ]. Other treatments for HRS have also been assessed and include dopamine, transjugular intrahepatic portosystemic shunt, and renal and liver replacement therapy.…”

Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

“…Other treatments for HRS have also been assessed and include dopamine, transjugular intrahepatic portosystemic shunt, and renal and liver replacement therapy. However, current thinking is that liver transplantation in the only curative option and should be considered in all patients[ 247 , 257 ].…”

Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

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Fluid balance concepts in medicine: Principles and practice

Roumelioti¹,

Glew²,

Khitan³

et al. 2018

WJN

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The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.

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Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

Section: Body Fluid Balance In Severe Chronic or Acute Illnessmentioning

confidence: 99%

See 1 more Smart Citation

Fluid balance concepts in medicine: Principles and practice

Roumelioti¹,

Glew²,

Khitan³

et al. 2018

WJN

View full text Add to dashboard Cite

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“…As per the ICA 2007 guidelines, HRS has been classified into two types, based on the rate of rise in SCr in association with cirrhosis [ 12 , 24 , 36 ]. Type-1 HRS (HRS-1) is defined as “doubling of the serum creatinine to a level greater than 2.5 mg/dL in less than 2 weeks’ duration.” Type-2 HRS (HRS-2), on the other hand, is defined as a gradual rise in SCr to > 1.5 mg/dl.…”

Section: Hepatorenal Syndromementioning

confidence: 99%

Acute kidney injury in children with chronic liver disease

2018

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Acute kidney injury (AKI) is a common accompaniment in patients with liver disease. The causes, risk factors, manifestations and management of AKI in these patients vary according to the liver disease in question (acute liver failure, acute-on-chronic liver failure, post-liver transplantation or metabolic liver disease). There are multiple causes of AKI in patients with liver disease—pre-renal, acute tubular necrosis, post-renal, drug-induced renal failure and hepatorenal syndrome (HRS). Definitions of AKI in liver failure are periodically revised and updated, but pediatric definitions have still to see the light of the day. As our understanding of the pathophysiology of liver disease and renal involvement improves, treatment modalities have become more advanced and rationalized. Treatment includes reversing precipitating factors, such as infections and gastrointestinal bleeding, volume expansion, paracentesis and vasoconstrictors. This approach is tried and tested in adults. A pediatric tailored approach is still lacking due to inadequate numbers of patients, differences in causes of AKI and paucity of literature. In this review, we attempt to explore the pathophysiological basis, treatment modalities and controversies in the diagnosis and treatment of AKI in pediatric patients with chronic liver disease and discuss our own personal practice. We recognize that, although it is not a very commonly encountered entity in pediatric population, HRS has specific diagnostic criteria and treatment modalities that differ from other causes of AKI in patients with chronic liver disease; hence among the etiologies of kidney injury in patients with chronic liver disease, we focus here on HRS.

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“…For some authors [ 5 , 6 , 7 , 8 , 9 ] the use of TIPS shall not be recommended in HRS-1 patients. Of course this consideration in relation to the serious clinical condition of these patients is shareable, although in our experience for patients already on a list for liver transplantation or in a particularly severe clinical condition, TIPS, in view of the high mortality rate in the short term, can be a useful ‘bridge’ therapy.…”

mentioning

confidence: 99%

Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A Delphi technique-based consensus

Abstract: Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.

Cited by 12 publications

References 60 publications

Fluid balance concepts in medicine: Principles and practice

Fluid balance concepts in medicine: Principles and practice

Acute kidney injury in children with chronic liver disease

Hepatorenal syndrome: role of the transjugular intrahepatic stent shunt in real life practice

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