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Hepatorenal syndrom

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https://www.readbyqxmd.com/read/29471569/does-transjugular-intrahepatic-portosystemic-shunt-stent-differentially-improve-survival-in-a-subset-of-cirrhotic-patients
#1
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
https://www.readbyqxmd.com/read/29469046/treatment-of-type-1-hepatorenal-syndrome-with-pentoxifylline-a-randomized-placebo-controlled-clinical-trial
#2
Jonathan G Stine, Jennifer Wang, Scott L Cornella, Brian W Behm, Zachary Henry, Neeral L Shah, Stephen H Caldwell, Patrick G Northup
INTRODUCTION: Type-1 hepatorenal syndrome (HRS-1) portends a poor prognosis in patients with cirrhosis. Currently available medical therapies are largely ineffective, save for liver transplantation. We aimed to determine if pentoxifylline (PTX) therapy in addition to the standard of care of volume expansion with albumin and vasoconstriction with midodrine and octreotide (AMO) is safe and efficacious compared to AMO in HRS-1 treatment. MATERIAL AND METHODS: Hospitalized subjects with decompensated cirrhosis and HRS-1 were enrolled...
March 1, 2018: Annals of Hepatology
https://www.readbyqxmd.com/read/29432366/systemic-hemodynamic-response-to-terlipressin-predicts-development-of-hepatorenal-syndrome-and-survival-in-advanced-cirrhosis
#3
Georgios N Kalambokis, Ilias Tsiakas, Maria Christaki, Christina Koustousi, Leonidas Christou, Gerasimos Baltayiannis, Dimitrios Christodoulou
BACKGROUND: The aim of this study was to predict the occurrence of hepatorenal syndrome (HRS) and death in patients with advanced cirrhosis and ascites. PATIENTS AND METHODS: We retrospectively evaluated 2-year data of 78 patients with cirrhosis and ascites (Child-Pugh B/C: 45/43). The mean arterial pressure (MAP) and cardiac output (CO) were measured in all patients just before administration of 2 mg of terlipressin and 30 min later. Systemic vascular resistance (SVR) was calculated as MAP/CO...
February 9, 2018: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29422242/transjugular-intrahepatic-portosystemic-shunt-for-hepatorenal-syndrome-a-systematic-review-and-meta-analysis
#4
REVIEW
Tingxue Song, Martin Rössle, Fuliang He, Fuquan Liu, Xiaozhong Guo, Xingshun Qi
BACKGROUND: Hepatorenal syndrome is a severe complication of advanced liver diseases with a dismal prognosis. AIMS: This systematic review and meta-analysis aims to explore the efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of hepatorenal syndrome. METHOD: Publications were searched via PubMed and EMBASE databases. The pooled proportion and mean difference were calculated by using a random-effect model...
February 5, 2018: Digestive and Liver Disease
https://www.readbyqxmd.com/read/29391267/association-between-grade-of-acute-on-chronic-liver-failure-and-response-to-terlipressin-and-albumin-in-patients-with-hepatorenal-syndrome
#5
Salvatore Piano, Hartmut H Schmidt, Xavier Ariza, Alex Amoros, Antonietta Romano, Anna Hüsing-Kabar, Elsa Solà, Alexander Gerbes, Mauro Bernardi, Carlo Alessandria, Bernhard Scheiner, Marta Tonon, Miriam Maschmeier, Cristina Solè, Jonel Trebicka, Thierry Gustot, Frederik Nevens, Vicente Arroyo, Pere Gines, Paolo Angeli
BACKGROUND & AIMS: Type-1 hepatorenal syndrome (HRS) is the most high-risk type of renal failure in patients with cirrhosis. Terlipressin and albumin are effective treatments for type-1 HRS. However, the effects of acute on chronic liver failure (ACLF) grade on response to treatment are not clear. We aimed to identify factors associated with response to treatment with terlipressin and albumin in patients with type 1 HRS (reduction in serum level of creatinine to below 1.5 mg/dl at the end of treatment) and factors associated with death within 90 days of HRS diagnosis (90-day mortality)...
January 29, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29362613/protective-effects-of-the-third-generation-vasodilatory-%C3%AE-eta-blocker-nebivolol-against-d-galactosamine-induced-hepatorenal-syndrome-in-rats
#6
Ahmed Atwa, Rehab Hegazy, Rania Mohsen, Neamat Yassin, Sanaa Kenawy
BACKGROUND: Renal dysfunction is very common in patients with advanced liver cirrhosis and portal hypertension. The development of renal failure in the absence of clinical, anatomical or pathological causes renal of failure is termed hepatorenal syndrome (HRS). AIM: The present study was constructed to investigate the possible protective effects of nebivolol (Nebi) against D-galactosamine (Gal)-induced HRS in rats. MATERIAL AND METHODS: Rats were treated with Nebi for ten successive days...
December 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29361048/role-of-the-cytochrome-p-450-epoxyeicosatrienoic-acids-pathway-in-the-pathogenesis-of-renal-dysfunction-in-cirrhosis
#7
Michael M Yeboah, Md Abdul Hye Khan, Marla A Chesnik, Melissa Skibba, Lauren L Kolb, John D Imig
Background: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver cirrhosis that is characterized by hemodynamic alterations in the kidney and other vascular beds. Cytochrome P(CYP)-450 enzymes metabolize arachidonic acid to epoxyeicosatrienoic acids (EETs) and 20-hydroxyeicosatetraenoic acids. These eicosanoids regulate blood pressure, vascular tone and renal tubular sodium transport under both physiological and pathophysiological states. Methods: Experiments were performed to investigate the role of the CYP system in the pathogenesis of renal dysfunction during cirrhosis...
January 19, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29327821/chronic-kidney-disease-in-patients-with-chronic-hepatitis-c-virus-infection
#8
Omer Shahab, Pegah Golabi, Zobair M Younossi
Hepatitis C virus (HCV) infection affects many organs in the body, including the liver, kidneys, skin, joints and others. Although the hepatic manifestation of HCV has been widely studied, the extrahepatic manifestaions of HCV have not been fully appreciated. Studies have shown that patients with HCV have a higher risk of chronic kidney disease and end-stage renal disease, as well as poorer outcomes after kidney transplantation. Given these findings, it is important to screen HCV patients for presence of renal impairement in a timely manner...
January 10, 2018: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/29315697/fractional-excretion-of-urea-a-simple-tool-for-the-differential-diagnosis-of-acute-kidney-injury-in-cirrhosis
#9
Kavish R Patidar, Le Kang, Jasmohan S Bajaj, Daniel Carl, Arun J Sanyal
Current approaches to determine the cause of acute kidney injury (AKI) in patients with cirrhosis are suboptimal. The aim of this study was to determine the utility of fractional excretion of urea (FEUrea) for the differential diagnosis of AKI in cirrhotic patients. A retrospective analysis was performed in patients (n=50) with cirrhosis and ascites admitted with AKI. Using adjudicated etiology assessment as the reference standard, receiver operating curves (ROC) and optimal cutoff, sensitivity (Sn) and specificity (Sp) for the diagnosis of prerenal azotemia (PRA), type 1 hepatorenal syndrome (HRS) and acute tubular necrosis (ATN) was derived...
January 8, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29312606/induction-of-renal-artery-hyperresponsiveness-by-alpha1-adrenoceptor-in-hepatorenal-syndrome
#10
Xiaogang Zhang, Xinsen Xu, Yina Jiang, Jianyu He, Wenjing Wang, Wei Li, Xufeng Zhang, Yi Lv
Objective: To investigate the potential role of alpha1-adrenoceptor (α1-AR) in the pathogenesis of hepatorenal syndrome. Methods: Hepatorenal syndrome was induced in male rats by intraperitoneal injection of D-galactosamine and orally treatment with α1-AR antagonist tamsulosin. Hyperresponsiveness of the renal artery contraction was evaluated by the laser-Doppler flowmetry and multimyograph system, while renal blood flow (cortical and medullary perfusion) was simultaneously measured...
December 12, 2017: Oncotarget
https://www.readbyqxmd.com/read/29303765/circulating-mir-21-mir-210-and-mir-146a-as-potential-biomarkers-to-differentiate-acute-tubular-necrosis-from-hepatorenal-syndrome-in-patients-with-liver-cirrhosis-a-pilot-study
#11
Mona Mohamed Watany, Rasha Youssef Hagag, Hanaa Ibrahim Okda
BACKGROUND: Acute kidney injury (AKI) in cirrhotic patients may be functional (hepatorenal syndrome [HRS]) or structural (acute tubular necrosis [ATN]). The differentiation between these two conditions remains challenging; no definite biomarker with a clear cutoff value had been declared. miRNAs seem to be attractive innovative biomarkers to identify the nature of kidney injury in cirrhotic patients. This study aimed to investigate the possibility of using miR-21, miR-210 and miR-146a as differentiating markers between HRS and ATN...
January 5, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29290508/the-emergency-medicine-evaluation-and-management-of-the-patient-with-cirrhosis
#12
REVIEW
Brit Long, Alex Koyfman
BACKGROUND: Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider. OBJECTIVE OF THE REVIEW: Provide an evidence-based update for the resuscitation of decompensating cirrhotic patients and an overview of cirrhosis complications...
December 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29258378/hepatorenal-syndrome-the-clinical-impact-of-vasoactive-therapy
#13
Isabelle Colle, Pierre-François Laterre
Hepatorenal syndrome (HRS) is a unique form of acute kidney injury seen in cirrhotic patients and associated with significant mortality and morbidity. Despite its impact, diagnosis and treatment of HRS remains challenging and this review aims to assess and compare the available vasoconstrictors used as first-line treatment for HRS. Areas covered: A literature review was undertaken on the use of vasoconstrictors in HRS, using PubMed/Medline database searches of: 'hepatorenal syndrome', 'HRS' and 'vasoconstrictor'...
February 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29240010/well-preserved-renal-function-in-children-with-untreated-chronic-liver-disease
#14
Ulla B Berg, Antal Németh
OBJECTIVES: Based on studies with hepatorenal syndrome, it is widely regarded that renal function is impacted in chronic liver disease. Therefore we investigated renal function in our children with chronic liver disease. METHODS: In a retrospective study of 277 children with chronic liver disease, renal function was investigated as glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), measured as clearance of inulin and para-amino hippuric acid or clearance of iohexol...
December 12, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29239266/epidemiology-of-invasive-pulmonary-aspergillosis-in-patients-with-liver-failure-clinical-presentation-risk-factors-and-outcomes
#15
Xuan Zhang, Meifang Yang, Jianhua Hu, Hong Zhao, Lanjuan Li
Objective Invasive pulmonary aspergillosis (IPA) is a severe and often lethal infection. The possible risk factors, clinical presentation, and treatment of patients with simultaneous liver failure and IPA have received little attention in previous studies. The aim of this study was to investigate the epidemiology of IPA in patients with liver failure in an effort to reduce patient mortality. Methods The patients with liver failure (including acute liver failure , sub-acute liver failure , acute-on-chronic liver failure and chronic liver failure) were recruited from 2011 to 2016...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/29151800/hepatorenal-syndrome-role-of-the-transjugular-intrahepatic-stent-shunt-in-real-life-practice
#16
Gianni Testino
No abstract text is available yet for this article.
2017: Clujul Medical (1957)
https://www.readbyqxmd.com/read/29129539/leptospirosis-report-from-the-task-force-on-tropical-diseases-by-the-world-federation-of-societies-of-intensive-and-critical-care-medicine
#17
REVIEW
Juan Ignacio Silesky Jiménez, Jorge Luis Hidalgo Marroquin, Guy A Richards, Pravin Amin
Leptospirosis is a zoonosis caused by a gram negative aerobic spirochete of the genus Leptospira. It is acquired by contact with urine or reproductive fluids from infected animals, or by inoculation from contaminated water or soil. The disease has a global distribution, mainly in tropical and subtropical regions that have a humid, rainy climate and is also common in travelers returning from these regions. Clinical suspicion is critical for the diagnosis and it should be included in the differential diagnosis of any patient with a febrile hepatorenal syndrome in, or returning from endemic regions...
November 9, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29122911/prognosis-of-patients-with-cirrhosis-and-aki-who-initiate-rrt
#18
Andrew S Allegretti, Xavier Vela Parada, Nwamaka D Eneanya, Hannah Gilligan, Dihua Xu, Sophia Zhao, Jules L Dienstag, Raymond T Chung, Ravi I Thadhani
BACKGROUND AND OBJECTIVES: Literature on the prognosis of patients with cirrhosis who require RRT for AKI is sparse and is confounded by liver transplant eligibility. An update on outcomes in the nonlisted subgroup is needed. Our objective was to compare outcomes in this group between those diagnosed with hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective cohort study of patients with cirrhosis acutely initiated on hemodialysis or continuous RRT at five hospitals, including one liver transplant center...
January 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29115798/acute-alcoholic-hepatitis-a-literature-review-and-proposal-of-treatment
#19
Gianni Testino, Silvia Leone
Severe acute alcoholic hepatitis (AAH) can lead to a clinical picture with a sixmonth mortality rate in more than 70% of cases. This clinical picture is characterized by: jaundice with a duration of less than three months, jaundice at the first failure event, serum bilirubin greater than 5 mg / dL, ratio AST / ALT> 2: 1, AST less than 500 IU / L, ALT <300 IU / L, neutrophil leukocytosis and a GGT increase. In addition, encephalopathy, fever, asthenia and coagulopathy may be present. Its onset may also be characterized by portalhypertensionrelated complications, particularly bleeding and hepatorenal syndrome...
November 7, 2017: Minerva Medica
https://www.readbyqxmd.com/read/29111999/terlipressin-is-superior-to-midodrine-octreotide-for-hepatorenal-syndrome-type-1
#20
Georgios N Kalambokis, Gerasimos Baltayiannis, Dimitrios Christodoulou, Leonidas Christou
No abstract text is available yet for this article.
December 2017: European Journal of Gastroenterology & Hepatology
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