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Florence Wong
Hepatorenal syndrome (HRS) is a serious complication of advanced cirrhosis with ascites. HRS develops as a result of abnormal haemodynamics, leading to splanchnic and systemic vasodilatation, but renal vasoconstriction. Increased bacterial translocation, various cytokines and mesenteric angiogenesis also contribute to splanchnic vasodilatation, and altered renal autoregulation is involved in the renal vasoconstriction. Type 1 HRS is usually initiated by a precipitating event associated with an exaggerated systemic inflammatory response that perturbs haemodynamics, resulting in multiorgan failure...
July 2012: Nature Reviews. Gastroenterology & Hepatology
Ezequiel Rodríguez, Chiara Elia, Elsa Solà, Rogelio Barreto, Isabel Graupera, Alida Andrealli, Gustavo Pereira, Maria Poca, Jordi Sánchez, Mónica Guevara, Germán Soriano, Carlo Alessandria, Javier Fernández, Vicente Arroyo, Pere Ginès
BACKGROUND & AIMS: Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy...
May 2014: Journal of Hepatology
Paolo Angeli, Pere Gines
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis that is associated with poor survival. A rapid diagnosis of HRS and a prompt initiation of the treatment with terlipressin and albumin are mandatory because this leads to an improvement of prognosis. This review covers the predictive value of HRS on 3-month mortality beyond the MELD score and its consequential impact on the prioritization policy to liver transplantation (LT). Moreover, it analyzes the impact of the response to pharmacological treatment on the MELD score, its possible delaying effect on the timing of LT, and suggests a way of overcoming the paradoxical effect of terlipressin and albumin on the priority to LT in responders...
November 2012: Journal of Hepatology
Virendra Singh, Souvik Ghosh, Baljinder Singh, Pradeep Kumar, Navneet Sharma, Ashish Bhalla, A K Sharma, N S Choudhary, Yogesh Chawla, C K Nain
BACKGROUND & AIMS: Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS. METHODS: Forty-six patients with HRS type 1 were managed with terlipressin (group A, N=23) or noradrenaline (Group B, N=23) with albumin in a randomized controlled trial at a tertiary center. RESULTS: HRS reversal could be achieved in 9 (39...
June 2012: Journal of Hepatology
Andrew Davenport, Jawad Ahmad, Ali Al-Khafaji, John A Kellum, Yuri S Genyk, Mitra K Nadim
Hepatorenal syndrome (HRS) is defined as the occurrence of renal dysfunction in a patient with end-stage liver cirrhosis in the absence of another identifiable cause of renal failure. The prognosis of HRS remains poor, with a median survival without liver transplantation of <6 months. However, understanding the pathogenesis of HRS has led to the introduction of treatments designed to increase renal perfusion and mean arterial blood pressure using vasopressors and albumin, which has led to improvement in renal function in ∼50% of patients...
January 2012: Nephrology, Dialysis, Transplantation
Michael Schepke
No abstract text is available yet for this article.
September 2007: Nephrology, Dialysis, Transplantation
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