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Hepatorenal syndrome

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https://www.readbyqxmd.com/read/28321803/prognosis-of-cirrhotic-patients-admitted-to-intensive-care-unit-a-meta-analysis
#1
Delphine Weil, Eric Levesque, Marc McPhail, Rodrigo Cavallazzi, Eleni Theocharidou, Evangelos Cholongitas, Arnaud Galbois, Heng Chih Pan, Constantine J Karvellas, Bertrand Sauneuf, René Robert, Jérome Fichet, Gaël Piton, Thierry Thevenot, Gilles Capellier, Vincent Di Martino
BACKGROUND: The best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown. METHODS: We conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28303201/erratum-metabolic-syndrome-and-the-hepatorenal-reflex
#2
(no author information available yet)
[This corrects the article on p. 83 in vol. 7, PMID: 27656314.].
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28297776/-value-of-thromboelastography-in-evaluating-coagulation-function-and-prognosis-in-patients-with-acute-on-chronic-liver-failure
#3
Y L Zeng, F Gao, J F Wei, H R Hou, X Jin, G G Ding, H Yin, J Shang, Y Kang
Objective: To investigate the coagulation function in patients with acute-on-chronic liver failure (ACLF) patients using thromboelastography (TEG), and to comprehensively and dynamically evaluate patients' bleeding and coagulation status. Methods: The clinical data of ACLF patients were collected, and TEG was used to evaluate whole blood clotting kinetics in these patients. Routine biochemical parameters were measured, and complications were evaluated. The t-test was used for comparison of continuous data, the chi-square test was used for comparison of categorical data, and the Pearson correlation coefficient was used for correlation analysis...
January 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28293919/-extracorporeal-liver-support-of-liver-failure
#4
Hans Ulrich Gerth, Michele Pohlen, Hermann Pavenstädt, Hartmut Schmidt
Extracorporeal liver support can be classified into cell-free, artificial methods (artificial liver support, ALS) and cell-based bioartificial methods (bioartificial liver support, BLS). ALS improves biochemical parameters of liver failure by the simultaneous removal of protein-bound and water-soluble substances. Here, the MARS therapy belongs to the most studied methods with a proved beneficial effect on hepatic encephalopathy (HE), hepatorenal syndrome (HRS) or hyperbilirubinemia. However, a general survival advantage of any liver support for liver failure has not been shown yet and is restricted to meta-analyses or patient subgroups...
March 14, 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/28293378/hepatorenal-syndrome-update-on-diagnosis-and-therapy
#5
EDITORIAL
Juan G Acevedo, Matthew E Cramp
Hepatorenal syndrome (HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality. A new definition has been recently recommended by the International Club of Ascites, according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value. Moreover, new data on urinary biomarkers has been recently published. In this sense, the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm...
February 28, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28245243/serelaxin-as-a-potential-treatment-for-renal-dysfunction-in-cirrhosis-preclinical-evaluation-and-results-of-a-randomized-phase-2-trial
#6
Victoria K Snowdon, Neil J Lachlan, Anna M Hoy, Patrick W F Hadoke, Scott I Semple, Dilip Patel, Will Mungall, Timothy J Kendall, Adrian Thomson, Ross J Lennen, Maurits A Jansen, Carmel M Moran, Antonella Pellicoro, Prakash Ramachandran, Isaac Shaw, Rebecca L Aucott, Thomas Severin, Rajnish Saini, Judy Pak, Denise Yates, Neelesh Dongre, Jeremy S Duffield, David J Webb, John P Iredale, Peter C Hayes, Jonathan A Fallowfield
BACKGROUND: Chronic liver scarring from any cause leads to cirrhosis, portal hypertension, and a progressive decline in renal blood flow and renal function. Extreme renal vasoconstriction characterizes hepatorenal syndrome, a functional and potentially reversible form of acute kidney injury in patients with advanced cirrhosis, but current therapy with systemic vasoconstrictors is ineffective in a substantial proportion of patients and is limited by ischemic adverse events. Serelaxin (recombinant human relaxin-2) is a peptide molecule with anti-fibrotic and vasoprotective properties that binds to relaxin family peptide receptor-1 (RXFP1) and has been shown to increase renal perfusion in healthy human volunteers...
February 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28226199/mortality-risk-factors-among-patients-with-cirrhosis-and-a-low-%C3%A2-15-meld-sodium-score-an-analysis-of-liver-transplant-allocation-policy-using-aggregated-electronic-health-record-data
#7
K Atiemo, A Skaro, H Maddur, L Zhao, S Montag, L VanWagner, S Goel, A Kho, B Ho, R Kang, J L Holl, M M Abecassis, J Levitsy, D P Ladner
Although the MELDNa score is now used for liver transplant allocation in the United States, mortality prediction may be underestimated by the score. Using aggregated electronic health record data from 7,834 adult patients with cirrhosis, we determined whether the cause of cirrhosis/cirrhosis complications is associated with an increased risk of death among patients with a MELDNa ≤15 and whether patients with the greatest risk of death could benefit from liver transplantation (LT). Over a median follow-up of 2...
February 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28176190/relative-adrenal-insufficiency-in-patients-with-cirrhosis-a-systematic-review-and-meta-analysis
#8
Gaeun Kim, Ji Hye Huh, Kyong Joo Lee, Moon Young Kim, Kwang Yong Shim, Soon Koo Baik
BACKGROUND: Relative adrenal insufficiency (RAI) is frequently observed in patients with cirrhosis. We sought to identify evidence in the literature regarding the impact of RAI on clinical outcomes in cirrhotic patients. METHODS: We conducted a systematic review (SR) and meta-analysis (MA) using the Ovid-MEDLINE, EMBASE, and Cochrane Library databases to identify relevant studies in the literature. RESULTS: Of the 182 studies identified, 16 were eligible according to our inclusion criteria...
April 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28151755/renal-cystic-disease-and-associated-ciliopathies
#9
Karl O Kagan, Andreas Dufke, Ulrich Gembruch
PURPOSE OF REVIEW: To review disorders that are associated with renal cystic disease during prenatal life and to highlight the strong association between renal cystic disease and ciliopathies. RECENT FINDINGS: There are numerous causative genes for ciliopathies that can present with cystic kidney disease. In the group of single gene ciliopathies, autosomal dominant polycystic kidney disease is by far the most prevalent one. Other examples are autosomal recessive polycystic kidney disease, nephronophthisis, Bardet-Biedl syndrome, Meckel-Gruber syndrome, Joubert syndrome and related disorders as well as X-linked orofaciodigital syndrome type 1, respectively...
April 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28124314/microalbuminuria-systemic-inflammation-and-multiorgan-dysfunction-in-decompensated-cirrhosis-evidence-for-a-nonfunctional-mechanism-of-hepatorenal-syndrome
#10
EDITORIAL
Vicente Arroyo
No abstract text is available yet for this article.
January 25, 2017: Hepatology International
https://www.readbyqxmd.com/read/28112958/cutaneous-necrosis-secondary-to-terlipressin-therapy-a-rare-but-serious-side-effect-case-report-and-literature-review
#11
Enrique Iglesias Julián, Ester Badía Aranda, Belén Bernad Cabredo, Daniel Corrales Cruz, María José Romero Arauzo
Terlipressin is a vasopressin analogue used in esophageal variceal bleeding and hepatorenal syndrome management. It is a safe drug with mild secondary effects. However, potentially serious ischemic complications may occur, such as cutaneous necrosis. It is useful to recognize these events early, in order to withdraw terlipressin and introduce other adjuvant drugs if needed. We report a detailed case of cutaneous necrosis secondary to terlipressin administration and present a case review of patients, describing their characteristics, risk factors, lesion locations, doses, methods of administration and possible treatments...
January 23, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28074870/microrna-155-is-upregulated-in-ascites-in-patients-with-spontaneous-bacterial-peritonitis
#12
Philipp Lutz, Mohamed M Haimid, Alessandra Pohlmann, Jennifer Lehmann, Christian Jansen, Robert Schierwagen, Sabine Klein, Christian P Strassburg, Ulrich Spengler, Jonel Trebicka
MircoRNA's (miR) have been recognised as important modulators of gene expression and potential biomarkers. However, they have been rarely investigated in bio fluids apart from blood. We investigated the association of miR-125b and miR-155 with complications of cirrhosis. Ascites was prospectively collected from patients with cirrhosis undergoing paracentesis at our department. miR's were determined in the supernatant using qPCR and normalized by SV-40. Clinical parameters were assessed at paracentesis and during follow-up...
January 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28052631/why-and-how-to-measure-renal-function-in-patients-with-liver-disease
#13
REVIEW
Salvatore Piano, Antonietta Romano, Marco Di Pascoli, Paolo Angeli
Patients with advanced liver disease frequently have impaired renal function. Both acute kidney injury (AKI) and chronic kidney disease (CKD) are quite common in patients with cirrhosis and both are associated with a worse prognosis in these patients. A careful assessment of renal function is highly important in these patients to help physicians determine their diagnosis, prognosis and therapeutic management and to define transplantation strategies (liver transplantation alone vs simultaneous liver and kidney transplantation)...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28052382/systematic-review-with-meta-analysis-vasoactive-drugs-for-the-treatment-of-hepatorenal-syndrome-type-1
#14
REVIEW
F J Gifford, J R Morling, J A Fallowfield
BACKGROUND: Hepatorenal syndrome type 1 (HRS1) is a functional, rapidly progressive, potentially reversible form of acute kidney injury occurring in patients with cirrhosis. Characterised by intense renal arterial vasoconstriction, it carries a very poor prognosis. There is a significant unmet need for a widely approved, safe and effective pharmacological treatment. AIM: To re-evaluate efficacy and safety of pharmacological treatments for HRS1, in the light of recently published randomised controlled trials (RCTs)...
March 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28029746/respiratory-manifestations-in-38-patients-with-alstr%C3%A3-m-syndrome
#15
Caroline Boerwinkle, Jan D Marshall, Joy Bryant, William A Gahl, Kenneth N Olivier, Meral Gunay-Aygun
OBJECTIVES: Alström syndrome (AS) is a rare, multi-system condition characterized by retinal degeneration, sensorineural hearing loss, obesity, insulin-resistant diabetes, hypertriglyceridemia, cardiomyopathy, hepatorenal disease, and recurrent respiratory infections. It belongs to a group of genetic disorders known as primary ciliopathies, which includes autosomal dominant and recessive polycystic kidney diseases, as well as Joubert and Bardet-Biedl syndromes. Prior studies have suggested phenotypic overlap between primary ciliopathies affecting the non-motile, sensory cilia, and primary ciliary dyskinesia (PCD), a motile ciliopathy characterized by respiratory tract disease...
December 28, 2016: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28013112/urine-interleukin-18-and-lipocalin-2-are-biomarkers-of-acute-tubular-necrosis-in-patients-with-cirrhosis-a-systematic-review-and-meta-analysis
#16
Jeremy Puthumana, Xavier Ariza, Justin M Belcher, Isabel Graupera, Pere Ginès, Chirag R Parikh
BACKGROUND & AIMS: Acute kidney injury (AKI) is a common complication in patients with cirrhosis that increases mortality. The most common causes of AKI in these patients are prerenal azotemia, acute tubular necrosis (ATN), and hepatorenal syndrome; it is important to determine the etiology of AKI to select the proper treatment and predict patient outcome. Urine biomarkers could be used to differentiate between patients with ATN and functional causes of AKI. We performed a systemic review and meta-analysis of published studies to determine whether urine levels of interleukin 18 (IL18) and lipocalin 2 (LCN2 or NGAL) associate with development of ATN in patients with cirrhosis...
December 21, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28008340/fractional-excretion-of-sodium-in-hepatorenal-syndrome-clinical-and-pathological-correlation
#17
Ali A Alsaad, Hani M Wadei
AIM: To determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODS: Eighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy...
December 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/28003716/pharmacologic-treatment-of-alcoholic-hepatitis-examining-outcomes-based-on-disease-severity-stratification
#18
Ryan E Owens, Heather S Snyder, Jennifer D Twilla, Sanjaya K Satapathy
OBJECTIVES: Maddrey discriminant function (MDF) score is a measure of disease prognosis in alcoholic hepatitis (AH) used to identify patients at highest risk of mortality and determine the need for initiation of pharmacologic treatment. The purpose of this study was to evaluate the effects of pharmacologic therapy for hospitalized AH patients as stratified by MDF score. METHODS: A retrospective review of patients with an AH diagnosis admitted to a Methodist LeBonheur Healthcare adult hospital between 06/2009 and 06/2014 was conducted...
December 2016: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/27987536/acute-kidney-injury-in-liver-cirrhosis-new-definition-and-application
#19
REVIEW
Florence Wong
The traditional diagnostic criteria of renal dysfunction in cirrhosis are a 50% increase in serum creatinine (SCr) with a final value above 1.5 mg/dL. This means that patients with milder degrees of renal dysfunction are not being diagnosed, and therefore not offered timely treatment. The International Ascites Club in 2015 adapted the term acute kidney injury (AKI) to represent acute renal dysfunction in cirrhosis, and defined it by an increase in SCr of 0.3 mg/dL (26.4 µmoL/L) in <48 hours, or a 50% increase in SCr from a baseline within ≤3 months...
December 2016: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/27984174/emergency-tips-in-a-child-pugh-b-patient-when-does-the-window-of-opportunity-open-and-close
#20
REVIEW
Jonel Trebicka
Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using endoscopic and medical treatment in patients with compensated cirrhosis; in decompensated patients, however, TIPS improves survival. Therefore, an early TIPS (within 72h or if later, still early after bleeding) might improve the survival of patients by preventing an inflammatory response and bacterial translocation...
October 29, 2016: Journal of Hepatology
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