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acute kidney failure cirrhosis

Ashwani K Singal, Song Ong, Sanjaya Satpathy, Patrick S Kamath, Russel H Wiesner
Kidney injury is frequently seen in patients with end stage liver disease from cirrhosis and liver failure. Among select patients, simultaneous liver kidney (SLK) transplantation provides improved post-transplant graft and patient outcomes compared to liver transplantation alone. We conducted review of the existing literature on SLK transplant criteria and outcomes. Since the introduction of the model for end-stage disease score in 2002, there has been an increased use of simultaneous liver kidney transplantation...
December 10, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Bertha Cárdenas Ramírez, P Martin Padilla-Machaca, Omar Mantilla Cruzatti, José Rivera Romaní, Carlos Rondón Leyva, José-Carlos Chaman Ortiz
INTRODUCTION: Hepatopulmonary syndrome (HPS) is a serious complication of liver disease, which is characterized by the presence of intrapulmonary vasodilation and progressive hypoxemia. Liver transplantation is the only effective treatment. OBJECTIVE: To show our results of patients with hepatopulmonary syndrome undergoing liver transplantation. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2016; 226 liver transplants were performed...
July 2018: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
W J Wang, Q Song, H G Ding
Objective: To investigate the clinical features and risk factors for acute kidney injury (AKI) in patients with cirrhosis. Methods: A total of 1 165 hospitalized patients with chronic liver diseases were enrolled. Among them, 94 patients had chronic hepatitis, while 1 071 patients were diagnosed as cirrhosis. The clinical data, renal and liver function were retrospectively analyzed. AKI was determined according to the criteria proposed by International Club of Ascites. Compared with chronic hepatitis group, the clinical features and risk factors for AKI in patients with cirrhosis were evaluated using logistic regression...
December 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Anthony Bonavia, Kai Singbartl
The liver and kidney are key organs of metabolic homeostasis in the body and display complex interactions. Liver diseases often have direct and immediate effects on renal physiology and function. Conversely, acute kidney injury (AKI) is a common problem in patients with both acute and chronic liver diseases. AKI in patients with acute liver failure is usually multifactorial and involves insults similar to those seen in the general AKI population. Liver cirrhosis affects and is directly affected by aberrations in systemic and renal hemodynamics, inflammatory response, renal handling of sodium and free water excretion, and additional nonvasomotor mechanisms...
October 2018: Seminars in Respiratory and Critical Care Medicine
Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber
Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common...
October 2018: Seminars in Respiratory and Critical Care Medicine
J Wu, L Jia, Y Y Li, J Li, H W Yu, Y K Zhu, Z J Hu, Q H Meng, F S Wang
Objective: To evaluate the incidence, and the characteristics of organ failure in relationship to prognosis in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients using chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score for judgments of clinical treatment and prognosis. Methods: Clinical data of 316 patients who were diagnosed as HBV-ACLF during hospitalization from February 2015 to February 2016 were retrospectively analyzed. Intrahepatic and extrahepatic organ failures were assessed according to CLIF-SOFA score, and the relationship between clinical characteristics and prognosis was analyzed...
October 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Jose Torrealba, Nathan T Sweed, Daniel Burguete, Allen R Hendricks
Bile cast nephropathy (BCN) is seen in patients who have acute kidney injury and severe hyperbilirubinemia due to a wide range of hepatobiliary system diseases. Findings seen by renal biopsy include acute tubular injury with necrotic and sloughed epithelial cells, yellow-green pigment within tubular epithelial cells, and pigmented granular casts. Hall's special stain for bile turns these casts green. In recent years, BCN has been described in a small number of case reports and clinical studies primarily in the setting of severe liver dysfunction...
September 2018: Case Reports in Nephrology and Dialysis
Lotte Borg Lange, Kristine Borg
This case report presents a 70-year-old man with alcoholic liver cirrhosis, who was hospitalised due to pulmonary oedema, and who developed acute renal injury. Though the criteria were not fulfilled, hepatorenal syndrome was suspected and treated with terlipressin, after which the patient developed severe penile ischaemia. Hepatorenal syndrome is one of many potential causes of acute kidney injury in patients with acute or chronic liver disease. The syndrome is an exclusion diagnosis, and other causes of liver and renal failure should be investigated, before treatment is started...
October 22, 2018: Ugeskrift for Laeger
Beate Appenrodt, Frank Lammert
Renal failure is a severe complication in patients with liver cirrhosis. It is associated with increased mortality and morbidity. Diagnosis is a challenge because it is mainly based on serum creatinine, which does not seem to be an ideal measure of renal function in cirrhosis. The definition of renal failure in these patients has been changed for optimizing treatment and for improving outcome and prognosis. The new criteria are based on the adapted KDIGO (Kidney Disease: Improving Global Outcomes) staging system...
August 2018: Visceral Medicine
Nicholas I Cole, Rebecca J Suckling, Pauline A Swift, Feng J He, Graham A MacGregor, William Hinton, Jeremy van Vlymen, Nicholas Hayward, Simon Jones, Simon de Lusignan
The mechanisms underlying the adverse cardiovascular effects of increased salt intake are incompletely understood, but parallel increases in serum sodium concentration may be of importance. The aim of this retrospective cohort study was to investigate the relationship between serum sodium, hypertension and incident cardiovascular disease (CVD). Routinely collected primary care data from the Royal College of General Practitioners Research and Surveillance Centre were analysed. A total of 231,545 individuals with a measurement of serum sodium concentration at baseline were included...
September 24, 2018: Journal of Human Hypertension
Bogdan Procopet, Petra Fischer, Adelina Horhat, Emil Mois, Horia Stefanescu, Mihai Comsa, Florin Graur, Adrian Bartos, Monica Lupsor-Platon, Radu Badea, Mircea Grigorescu, Marcel Tantau, Zeno Sparchez, Nadim Al Hajjar
The evaluation of patients with early hepatocellular carcinoma (HCC) referred for liver resection is still a matter of debate. Aims: 1) to compare liver stiffness measurement (LSM) by transient elastography with hepatic venous pressure gradient (HVPG) in the prediction of decompensation after liver resection in patients with cirrhosis and early HCC; 2) to identify which definition for posthepatectomy liver failure is better associated with survival. MATERIAL AND METHODS: Fifty-one patients (MELD score of 10±3) were included...
August 30, 2018: Medical Ultrasonography
Vinod Arora, Rakhi Maiwall, Rajan Vijayaraghavan, Ankur Jindal, Shasthry Saggere Muralikrishna, Guresh Kumar, Priyanka Jain, Shiv Kumar Sarin
BACKGROUND: Hepatorenal syndrome (HRS) carries a high short-term mortality in patients with cirrhosis and ACLF. Terlipressin and noradrenaline are routinely used in cirrhosis with HRS and have been found to be equally effective. There is no data comparing the efficacy of terlipressin with noradrenaline in ACLF patients with HRS. METHODS: In an open-label RCT, consecutive patients with ACLF diagnosed with HRS-AKI, were randomised to albumin with infusion of terlipressin (2-12 mg/d) (n=60) or noradrenaline (0...
August 3, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Evi V Nagler, Maria C Haller, Wim Van Biesen, Raymond Vanholder, Jonathan C Craig, Angela C Webster
BACKGROUND: Chronic (present > 48 hours) non-hypovolaemic hyponatraemia occurs frequently, can be caused by various conditions, and is associated with shorter survival and longer hospital stays. Many treatments, such as fluid restriction or vasopressin receptor antagonists can be used to improve the hyponatraemia, but whether that translates into improved patient-important outcomes is less certain. OBJECTIVES: This review aimed to 1) look at the benefits and harms of interventions for chronic non-hypovolaemic hypotonic hyponatraemia when compared with placebo, no treatment or head-to-head; and 2) determine if benefits and harms vary in absolute or relative terms dependent on the specific compound within a drug class, on the dosage used, or the underlying disorder causing the hyponatraemia...
June 28, 2018: Cochrane Database of Systematic Reviews
Adrienne Lenhart, Salwa Hussain, Reena Salgia
BACKGROUND: Acute kidney injury in the setting of alcoholic liver disease portends a poor prognosis without liver transplant. AIMS: Using a tertiary care population, we aimed to evaluate the outcomes of renal replacement therapy in patients with alcoholic liver disease and acute kidney injury with < 6 months sobriety. METHODS: A retrospective review of hospitalized patients with alcoholic hepatitis/acute on chronic alcoholic cirrhosis and hepatorenal syndrome or acute tubular necrosis was performed...
October 2018: Digestive Diseases and Sciences
Shalimar, Gyanranjan Rout, Shekhar S Jadaun, Gyan Ranjan, Saurabh Kedia, Deepak Gunjan, Baibaswata Nayak, Subrat Kumar Acharya, Ajay Kumar, Arti Kapil
BACKGROUND: Acute on chronic liver failure (ACLF) is associated with high short term mortality. We aimed to evaluate the prevalence, predictors and impact of bacterial infection in ACLF. METHODS: Consecutive hospitalized patients with cirrhosis and acute decompensation (AD), from January 2011-March 2017, were included. Predictors of survival and infection were assessed. RESULTS: 572 patients with cirrhosis and AD were classified into 3 groups - no infection (group 1, n = 190, 33...
November 2018: Digestive and Liver Disease
Qun-Qun Jiang, Mei-Fang Han, Ke Ma, Guang Chen, Xiao-Yang Wan, Semvua Bukheti Kilonzo, Wen-Yu Wu, Yong-Li Wang, Jie You, Qin Ning
AIM: To evaluate the differences in acute kidney injury (AKI) between acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC) patients. METHODS: During the period from December 2015 to July 2017, 280 patients with hepatitis B virus (HBV)-related ACLF (HBV-ACLF) and 132 patients with HBV-related DC (HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid binding protein (L-FABP), cystatin C (CysC), and kidney injury molecule-1 (KIM-1)...
June 7, 2018: World Journal of Gastroenterology: WJG
Marta Carneiro de Moura, Shiyi Chen, Binita M Kamath, Vicky L Ng, Simon C Ling
BACKGROUND AND AIMS: The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors. METHODS: We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015...
September 2018: Journal of Pediatric Gastroenterology and Nutrition
Filippo Valbusa, Davide Agnoletti, Luca Scala, Cristina Grillo, Pietro Arduini, Stefano Bonapace, Stefano Calabria, Giuliana Scaturro, Alessandro Mantovani, Giacomo Zoppini, Emanuela Turcato, Aldo Pietro Maggioni, Guido Arcaro, Giovanni Targher
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for incident heart failure (HF). It is currently unknown whether NAFLD predicts all-cause mortality in patients admitted for acute HF. We aimed to assess whether NAFLD and its severity (diagnosed by ultrasonography and non-invasive fibrosis biomarkers) were associated with increased all-cause mortality in this particularly high-risk patient population. METHODS: We studied 264 elderly patients, who were consecutively admitted for acute HF to the hospital between years 2013 and 2015, after excluding those with acute myocardial infarction, severe valvular heart diseases, kidney failure, cancer, cirrhosis of any etiology or known chronic liver diseases...
August 15, 2018: International Journal of Cardiology
Emilia T O Bansho, Pedro Eduardo S Silva, Bruno S Colombo, Letícia M Wildner, Maria Luiza Bazzo, Esther B Dantas-Corrêa, Leonardo L Schiavon, Janaína L Narciso-Schiavon
BACKGROUND: New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. MATERIAL AND METHODS: This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: &lt; 2x basal), 2 (2 or 3x), and 3 (&gt; 3x)...
May 2018: Annals of Hepatology
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is the culmination of chronic liver disease and extrahepatic organ failures, which is associated with a high short-term mortality and immense health care expenditure. There are varying definitions for organ failures and ACLF in Europe, North America, and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multifactorial and related to interactions between the immunoinflammatory system, microbiota, and the various precipitating factors...
October 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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