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hepatorenal syndromes

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https://www.readbyqxmd.com/read/29652753/hybrid-extracorporeal-therapies-as-a-bridge-to-pediatric-liver-transplantation
#1
Ayse Akcan Arikan, Poyyapakkam Srivaths, Ryan W Himes, Naile Tufan Pekkucuksen, Fong Lam, Trung Nguyen, Tamir Miloh, Michael Braun, John Goss, Moreshwar S Desai
OBJECTIVES: Standard intensive care treatment is inadequate to keep children with liver failure alive without catastrophic complications to ensure successful transplant, as accumulation of endogenous protein-bound toxins often lead to hepatic encephalopathy, hepatorenal syndrome, cardiovascular instability, and multiple organ failure. Given paucity of proven treatment modalities for liver failure, blood purification using different extracorporeal treatments as a bridge to transplantation is used, but studies evaluating the safety and efficacy of combination of these therapies, especially in pediatric liver failure, are lacking...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29643536/-genetic-diagnosis-of-caroli-syndrome-with-autosomal-recessive-polycystic-kidney-disease-a-case-report-and-literature-review
#2
X Y Yang, L P Zhu, X Q Liu, C Y Zhang, Y Yao, Y Wu
This case report is about one genetically specified diagnosed infant case of Caroli syndrome with autosomal recessive polycystic kidney disease (ARPKD) in China. The patient in this case report was an eight-month infant boy with an atypical onset and the main clinical manifestation was non-symptomatic enlargement of the liver and kidneys. The imaging study demonstrated a diffused cystic dilatation of intrahepatic bile ducts as well as polycystic changes in bilateral kidneys. The basic blood biochemical tests indicated a normal hepatorenal function...
April 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/29579867/multicentric-study-of-the-andalusian-experience-in-polycystic-liver-disease-as-indication-for-liver-transplantation
#3
S Dios-Barbeito, M Domínguez-Bastante, A Moreno-Navas, F J León-Díaz, Y Fundora-Suárez, F J Briceño-Delgado, M Pitarch-Martínez, M Á Gómez-Bravo
BACKGROUND: The purpose of this study was to determine the morbidity and survival in patients with polycystic liver disease (PLD) undergoing liver transplantation (LT) in 4 Spanish hospitals. METHODS: A multicentric retrospective study using a prospective database was designed including 19 LTs after PLD diagnosis performed from January 1, 1990, to December 31, 2016. Pediatric patients were excluded from the analysis. RESULTS: Of the included patients, 63...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29532591/un-precipitated-acute-kidney-injury-is-uncommon-among-stable-patients-with-cirrhosis-and-ascites
#4
Florence Wong, Peter Jepsen, Hugh Watson, Hendrik Vilstrup
BACKGROUND & AIMS: Acute episodes of renal dysfunction or acute kidney injury (AKI) in cirrhotic patients with ascites are mostly precipitated by an acute event. The prevalence of un-precipitated AKI in stable ascitic cirrhotic patients is unknown. The aims of this study were to determine (i) the prevalence of un-precipitated AKI in stable cirrhotics with ascites and (ii) any predictive factors for its development. METHODS: A total of 1115 stable cirrhotic patients with mild liver and renal dysfunction but varying degrees of ascites severity from 3 previous satavaptan vs placebo randomized controlled trials (Group A, ascites requiring diuretics but not paracentesis; Group B, ascites requiring frequent paracentesis; Group C, refractory ascites) were included...
March 13, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29530803/development-of-an-automated-phenotyping-algorithm-for-hepatorenal-syndrome
#5
Jejo D Koola, Sharon E Davis, Omar Al-Nimri, Sharidan K Parr, Daniel Fabbri, Bradley A Malin, Samuel B Ho, Michael E Matheny
OBJECTIVE: Hepatorenal Syndrome (HRS) is a devastating form of acute kidney injury (AKI) in advanced liver disease patients with high morbidity and mortality, but phenotyping algorithms have not yet been developed using large electronic health record (EHR) databases. We evaluated and compared multiple phenotyping methods to achieve an accurate algorithm for HRS identification. MATERIALS AND METHODS: A national retrospective cohort of patients with cirrhosis and AKI admitted to 124 Veterans Affairs hospitals was assembled from electronic health record data collected from 2005 to 2013...
March 9, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29528017/budd-chiari-syndrome-diagnosed-in-a-patient-listed-for-liver-transplant-and-considered-to-be-contraindicated-for-the-operation
#6
Kakharman Yesmembetov, Zhansaya Muratova, Sergey Borovskiy, Irina Ten, Kulpash Kaliaskarova
We report the clinical case of 23-year-old patient with liver cirrhosis of unknown genesis, significant resistant ascites, and 2 episodes of bleeding from esophageal varices. Evaluation did not find any cause of liver disease, and the patient was placed on the transplant wait list due to subcompensated liver function (Model for End-Stage Liver Disease score of 16, Child-Pugh class B) and poorly controlled severe portal hypertension. After treatment with diuretics, largevolume paracentesis, antibiotics, and vasoconstrictors, hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved significantly...
March 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29497824/acute-kidney-injury-in-children-with-chronic-liver-disease
#7
Akash Deep, Romit Saxena, Bipin Jose
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...
March 1, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29471569/does-transjugular-intrahepatic-portosystemic-shunt-stent-differentially-improve-survival-in-a-subset-of-cirrhotic-patients
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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...
April 25, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29290508/the-emergency-medicine-evaluation-and-management-of-the-patient-with-cirrhosis
#19
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
#20
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
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