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Acute kidney injury liver cirrhosis

Patricia Huelin, Salvatore Piano, Elsa Solà, Marialuisa Stanco, Cristina Solé, Rebeca Moreira, Elisa Pose, Silvano Fasolato, Nuria Fabrellas, Glòria de Prada, Chiara Pilutti, Isabel Graupera, Xavier Ariza, Antonietta Romano, Chiara Elia, Andrés Cárdenas, Javier Fernández, Paolo Angeli, Pere Ginès
BACKGROUND & AIMS: In patients with cirrhosis of the liver, acute kidney injury (AKI) is classified into 3 stages. Recent studies indicate that there are 2 subgroups of stage 1 disease, associated with different outcomes and serum levels of creatinine (sCr): stage 1A (sCr <1.5 mg/dL) and stage 1B (SCr ≥1.5 mg/dL). We performed a prospective study to validate, in a large series of patients with cirrhosis, the association between this new description and patient outcomes, as well as assess the relationship between AKI stage and the presence of acute-on-chronic liver failure (ACLF)...
October 5, 2016: Clinical Gastroenterology and Hepatology
Javier Fernández, Frédéric Bert, Marie-Hélène Nicolas-Chanoine
Antimicrobial resistance has become a major global public health security problem that needs coordinated approaches at regional, national and international levels. Antibiotic overuse and the failure of control measures to prevent the spread of resistant bacteria in the healthcare environment have led to an alarming increase in the number of infections caused by resistant bacteria, organisms that resist many (multi-drug and extensively drug-resistant strains), if not all (pan-drug-resistant bacteria) currently available antibiotics...
November 2016: Journal of Hepatology
Puneeta Tandon, Matthew T James, Juan G Abraldes, Constantine J Karvellas, Feng Ye, Neesh Pannu
BACKGROUND: The implementation of new serum creatinine (SCr)-based criteria for acute kidney injury (AKI) has brought to light several areas of uncertainty in patients with cirrhosis. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: Adults with cirrhosis hospitalized between 2002-2012. PREDICTOR: We aimed to address the prognostic implications of the new AKI criteria in cirrhosis. OUTCOMES: Baseline kidney function was defined from all outpatient SCr within 3 months before hospitalization...
2016: PloS One
Hong Zang, Fangfang Liu, Hongling Liu, Shaoli You, Bing Zhu, Zhihong Wan, Shaojie Xin
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a life-threatening complication in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. However, the characteristics of AKI in these patients have not been clarified. Our aim was to determine the incidence and risk factors of AKI and the association between AKI severity and 180-day transplant-free survival. METHODS: We performed a retrospective cohort analysis of patients with ACLF of underlying cirrhosis in a single center from January 2009 through December 2014...
September 2016: Hepatology International
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No abstract text is available yet for this article.
August 2016: Gut
X Shi, P Zhu, G Yan, C Liu, C Zhang, G Huang, Y Zhang, Z Yan, Y Wang
Acute kidney injury (AKI) is a common complication in patients with decompensated cirrhosis and is also an important cause for poor outcome. This study aimed at investigating the clinical characteristics and long-term prognosis of AKI in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). A total of 1167 patients with HBV-related ACLF from January 2010 to January 2015 were enrolled and divided into two groups, AKI group (n=308) and non-AKI group (n=859). All patients were followed up to investigate clinical characteristics, long-term overall survival (OS) and risk factors...
July 10, 2016: Journal of Viral Hepatitis
Kevin R Regner, Kai Singbartl
Acute kidney injury (AKI) occurs frequently in patients with liver disease and increases morbidity and mortality. Hepatorenal syndrome is a common cause of AKI in patients with decompensated cirrhosis and is due to alterations in systemic and renal hemodynamics. Serum creatinine-based estimation of kidney function is a key component of the Model for End-stage Liver Disease score in liver transplant candidates. Continuous renal replacement therapy is used in critically ill patients with liver failure and AKI...
July 2016: Critical Care Clinics
Hany M Dabbous, Iman F Montasser, Mohamed A Sakr, Rasha Refai, Moataz Sayam, Ahmed Abdelmonem, Hany Sayed, Mohamed F Abdelghafar, Mohamed Bahaa, Mahmoud S Elmeteini
BACKGROUND: Recurrence of HCV after living donor liver transplant (LDLT) is nearly universal, with almost one third of recipients developing cirrhosis and graft failure within 5 years after LDLT. Different studies have been published on the effect of sofosbuvir after liver transplantation on recurrent HCV with different genotypes. OBJECTIVES: The aim of this study was to evaluate the efficacy, safety, and tolerability of sofosbuvir and ribavirin in LDLT recipients with recurrent HCV genotype 4...
May 2016: Hepatitis Monthly
Claire Francoz, Mitra K Nadim, François Durand
Impaired renal function due to acute kidney injury (AKI) and/or chronic kidney diseases (CKD) is frequent in cirrhosis. Recurrent episodes of AKI may occur in end-stage cirrhosis. Differential diagnosis between functional (prerenal and hepatorenal syndrome) and acute tubular necrosis (ATN) is crucial. The concept that AKI and CKD represent a continuum rather than distinct entities, is now emerging. Not all patients with AKI have a potential for full recovery. Precise evaluation of kidney function and identification of kidney changes in patients with cirrhosis is central in predicting reversibility...
October 2016: Journal of Hepatology
Francois Durand, Mitra K Nadim
Acute-on-chronic liver failure (ACLF) is defined by the occurrence of organ failure(s) other than the liver in patients with cirrhosis. Even though mortality rates are high, there should no longer be reluctance to admit patients with ACLF in the intensive care unit. The prevalence of multidrug-resistant bacteria is high and broad spectrum antibiotics should be initiated as soon as infection is suspected. In patients with circulatory failure, the assessment of circulatory status is challenging due to the hyperkinetic state and an imbalance between the splanchnic and systemic blood volume...
May 2016: Seminars in Liver Disease
Alexander L Gerbes
BACKGROUND: Renal failure in cirrhosis may be due to various causes. While treatment for patients with ascites and hepatorenal syndrome is established, recent attention has been focused on acute kidney injury (AKI) in cirrhosis. KEY MESSAGES: The reduction of centrally effective blood volume is the key to the pathophysiology of renal failure and ascites formation in cirrhosis. Therefore, albumin infusion following large volume paracentesis is recommended by all guidelines...
2016: Digestive Diseases
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Renal failure commonly occurs in patients affected by cirrhosis, especially when there is ascites. It is typically secondary to intercurrent events that can further compromise blood flow in conditions of relatively decreased renal perfusion. Hepatorenal syndrome (HRS) is a particular and common type of kidney failure that affects patients with liver cirrhosis or, less frequently, with fulminant hepatic failure. The syndrome is characterized by splanchnic vasodilation and renal vasoconstriction. The classification of HRS identifies 2 categories of kidney failure, known as type 1 and type 2 HRS, that occur in patients with either cirrhosis or fulminant hepatic failure...
2016: Contributions to Nephrology
R Liberal, G Mieli-Vergani, D Vergani
Autoimmune hepatitis (AIH) is a progressive inflammatory hepatopathy and an important cause of end-stage liver disease. Its aetiology remains unknown, though both genetic and environmental factors are involved in its development. The major mechanism of autoimmune liver damage involves immune reactions against host liver antigens. Numerical and functional defects of regulatory T-cells play a permissive role enabling autoimmune liver injury to occur and persist. The most typical features of AIH are female preponderance, hypergammaglobulinaemia, seropositivity for circulating autoantibodies and a picture of interface hepatitis on histology...
May 6, 2016: Revista Clínica Española
Chinmaya Kumar Bal, Ripu Daman, Vikram Bhatia
AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis (SBP). METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP (during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm(3) in the peritoneal fluid...
April 28, 2016: World Journal of Hepatology
Hakan Yıldız, Meral Akdoğan, Nuretdin Suna, Erkin Öztaş, Ufuk B Kuzu, Zülfükar Bilge, Onur Aydınlı, İsmail Taşkıran
BACKGROUND/AIMS: Hemorrhagic ascites in patients with cirrhosis is described as a RBC (Red Blood cell) > 50,000/mm³ and leads to increased morbidity and mortality. Positive red blood cells at a level of less than 50,000/mm³ (10,000-50,000) may be encountered in the ascites but it is not known whether this is clinically significant or not. This study aimed to examine the outcome of hemorrhagic ascites in patients with advanced cirrhosis. MATERIALS AND METHODS: Data from 329 cirrhotic patients with ascites who received paracentesis at least once due to ascites was retrospectively analyzed from the period of 2007-2013 from the Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology...
July 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Florence Wong
Renal dysfunction in cirrhosis is mostly related to the development of acute kidney injury (AKI), precipitated by either an acute disturbance of hemodynamics, or acute structural damage to the kidneys. The incidence of chronic renal failure is rising, due to increasing prevalence of conditions such as diabetes, viral hepatitis, which can be associated with renal damage. AKI is defined as a rise in serum creatinine of 0.3 mg/dL in <48 hours or by 50% from baseline within the past 3 months without setting a threshold for the final serum creatinine...
September 2016: Minerva Gastroenterologica e Dietologica
X Ariza, I Graupera, M Coll, E Solà, R Barreto, E García, R Moreira, C Elia, M Morales-Ruiz, M Llopis, P Huelin, C Solé, N Fabrellas, E Weiss, F Nevens, A Gerbes, J Trebicka, F Saliba, C Fondevila, V Hernández-Gea, J Fernández, M Bernardi, V Arroyo, W Jiménez, C Deulofeu, M Pavesi, P Angeli, R Jalan, R Moreau, P Sancho-Bru, P Ginès
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in cirrhosis characterized by organ failure(s) and high mortality rate. There are no biomarkers of ACLF. The LCN2 gene and its product, neutrophil gelatinase-associated lipocalin (NGAL), are upregulated in experimental models of liver injury and cultured hepatocytes as a result of injury by toxins or proinflammatory cytokines, particularly Interleukin-6. The aim of this study was to investigate whether NGAL could be a biomarker of ACLF and whether LCN2 gene may be upregulated in the liver in ACLF...
July 2016: Journal of Hepatology
Stuart McPherson, Jessica Dyson, Andrew Austin, Mark Hudson
Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions and deaths due to liver disease have also increased. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol-related liver disease (ARLD) found that less than half the number of patients who died from ARLD received 'good care', and avoidable deaths were identified. In order to improve the care of patients admitted with ARLD, the NCEPOD report recommended that a 'toolkit' for the acute management of patients admitted with decompensated ARLD be developed and made widely available...
January 2016: Frontline Gastroenterology
Ahmed Mukhtar, Hany Dabbous
Splanchnic circulation is the primary mechanism that regulates volumes of circulating blood and systemic blood pressure in patients with cirrhosis accompanied by portal hypertension. Recently, interest has been expressed in modulating splanchnic circulation in patients with liver cirrhosis, because this capability might produce beneficial effects in cirrhotic patients undergoing a liver transplant. Pharmacologic modulation of splanchnic circulation by use of vasoconstrictors might minimize venous congestion, replenish central blood flow, and thus optimize management of blood volume during a liver transplant operation...
January 28, 2016: World Journal of Gastroenterology: WJG
V F Iovanescu, C T Streba, M Ionescu, A F Constantinescu, C C Vere, I Rogoveanu, E Moța
HYPOTHESIS: Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. OBJECTIVES: Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement...
October 2015: Journal of Medicine and Life
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