scholarly journals Liver Cirrhosis and Kidney

2016 ◽  
Vol 34 (4) ◽  
pp. 387-390 ◽  
Author(s):  
Alexander L. Gerbes
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Beta Blockers ◽  
Kidney Injury ◽  
Good Control ◽  
Intrahepatic Portosystemic Shunt ◽  
Prognostic Importance ◽  
Large Volume Paracentesis ◽  
Recent Attention

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. In selected patients, transjugular intrahepatic portosystemic shunt provides good control of ascites and improves survival. The role of non-selective beta-blockers in patients with cirrhosis and ascites is being controversially discussed. AKI in cirrhosis has been redefined and has prognostic importance. Conclusions: The role of kidney function in patients with liver cirrhosis is receiving increasing attention. In particular, the use of beta-blockers and novel definitions of AKI seem to be of clinical relevance.

scholarly journals Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

2020 ◽  
Vol 13 ◽  
pp. 175628482096128 ◽  
Author(s):  
Judit Vidal-González ◽  
Sergi Quiroga ◽  
Macarena Simón-Talero ◽  
Joan Genescà
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Portosystemic Shunt ◽  
Venous System ◽  
Variceal Hemorrhage ◽  
Portal Venous System ◽  
Portal Flow ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt

Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

scholarly journals Hepatorenal Syndrome: Diagnosis and Treatment – newsreel –

2016 ◽  
Vol 54 (3) ◽  
pp. 143-150 ◽  
Author(s):  
Aurelia Enescu ◽  
F. Petrescu ◽  
P. Mitruţ ◽  
Ileana Octavia Petrescu ◽  
V. Pădureanu ◽  
...  
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Hepatorenal Syndrome ◽  
Chronic Renal Disease ◽  
Therapeutic Modalities ◽  
Functional Nature ◽  
Acute Renal Insufficiency ◽  
Intrahepatic Portosystemic Shunt

Abstract Hepatorenal syndrome (HRS) is defined as renal failure that occurs in the presence of severe acute or chronic liver disease in the absence of underlying renal pathology. Due to the functional nature of the disease and the absence of specific diagnostic markers, HRS diagnosis is determined based on positive criteria associated with excluding other causes of renal failure in patients with liver cirrhosis and ascites. Differentiation from other types of acute or chronic renal disease is extremely difficult and therapeutic options are limited, prophylactic behavior is most appropriate in patients with severe hepatic disease and risk factors for the installation of hepatorenal syndrome. Highlighting all precipitating factors of acute renal insufficiency and therapeutic modalities in order to minimize adverse events is an important step in improving the follow-up of the patients with liver cirrhosis. The prognosis is reserved especially for type 1 HRS. Liver transplantation is the best option for patients without contraindications. The therapies introduced in recent years, such as vasoconstrictor drugs or transjugular intrahepatic portosystemic shunt are effective methods in the renal function improvement.

Acute kidney injury

2019 ◽  
pp. 217-224 ◽  
Author(s):  
Alex Harrison
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Urinary Tract ◽  
Kidney Injury ◽  
Renal Perfusion ◽  
Ultrasound Assessment ◽  
The Common

Ultrasound assessment of the urinary tract is frequently undertaken to identify post-renal or obstructive causes of renal failure. This chapter describes the normal renal sonoanatomy and the technique for scanning the renal tract, including the bladder. The sonographic features of the common pathology that may be identified are described, including the classification of hydronephrosis. The advanced section introduces the role of ultrasound in assessing renal perfusion.

scholarly journals Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria

2020 ◽  
Author(s):  
Nikolaus Pfisterer ◽  
Caroline Schmidbauer ◽  
Florian Riedl ◽  
Andreas Maieron ◽  
Vanessa Stadlbauer ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Beta Blockers ◽  
Primary Prophylaxis ◽  
Secondary Prophylaxis ◽  
Compensated Cirrhosis ◽  
Intrahepatic Portosystemic Shunt ◽  
Large Volume Paracentesis ◽  
The Individual ◽  
Small Varices ◽  
Early Tips

Summary Background Portal hypertension (PH) causes severe complications in patients with liver cirrhosis, such as variceal bleeding and ascites; however, data on the knowledge and perceptions on guideline recommendations for the management of varices and the use of albumin is scarce. Methods We designed two structured surveys on (i) the management of varices and (ii) the use of albumin for Austrian physicians of specialized Gastro-Intestinal (GI) centers. The interviewed physicians were confronted spontaneously and provided ad hoc responses to the questionnaire. Results In total, 158 surveys were completed. Interestingly, many specialists (30%) would recommend a follow-up gastroscopy after 1 year in patients with compensated cirrhosis without varices (i.e., overtreatment). For small varices, 81.5% would use non-selective beta blockers (NSBB) for primary prophylaxis (PP). For PP in patients with large varices, endoscopic band ligation (EBL) plus NSBB was preferred by 51.4% (i.e., overtreatment). Knowledge on the indication criteria for early TIPS (transjugular intrahepatic portosystemic shunt) was reported by 54.3%, but only 20% could report these criteria correctly. The majority (87.1%) correctly indicated a preference to use NSBB and EBL for secondary prophylaxis (SP). The majority of participating gastroenterologists reported no restrictions on the use of albumin (89.8%) in their hospitals. Of the interviewed specialists, 63.6% would use albumin in patients with SBP; however, only 11.4% would use the doses recommended by guidelines. The majority of specialists indicated using albumin at the recommended doses for hepatorenal syndrome (HRS-AKI, 86.4%) and for large volume paracentesis (LVP, 73.3%). The individual responses regarding albumin use for infections/sepsis, hyponatremia, renal impairment, and encephalopathy were heterogeneous. Conclusion The reported management of PH and varices is mostly adherent to guidelines, but endoscopic surveillance in patients without varices is too intense and EBL is overused in the setting of PP. Knowledge on the correct use of early TIPS must be improved among Austrian specialists. Albumin use is widely unrestricted in Austria; however, albumin is often underdosed in established indications.

scholarly journals Contrast induced acute kidney injury and the role of beta-blockers in its prevention

2019 ◽  
Vol 11 (7) ◽  
pp. 2689-2694
Author(s):  
Umberto Barbero ◽  
Mario Iannaccone ◽  
Michele De Benedictis ◽  
Baldassarre Doronzo
Keyword(s):  
Acute Kidney Injury ◽  
Beta Blockers ◽  
Kidney Injury

scholarly journals Crossing the chasm: caution for use of angiotensin receptor-neprilysin inhibition in patients with cardiogenic shock– a case report

2020 ◽  
Author(s):  
Loai Almazroa ◽  
Vesna Mihajlovic ◽  
Patrick R Lawler ◽  
Adriana Luk
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Cardiogenic Shock ◽  
Beta Blockers ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Risk Of Death

Abstract Background Vasoplegia has been reported in patients receiving angiotensin receptor-neprilysin inhibitors (ARNI) with heart failure with reduced ejection fraction (HFrEF). We present a case of vasoplegic shock after initiation of ARNI in a hospitalized 65-year-old man recovering from cardiogenic shock (CS) and acute kidney injury (AKI). Case summary A 65-year-old man with HFrEF presented to a community hospital with CS with evidence of poor perfusion with a lactate of 5.6 mmol/L and creatinine (Cr) 125 µmol/L. He was treated with intravenous furosemide infusion. Subsequently, his lactate normalized but he developed an AKI with a Cr of 176 µmol/L. He was then started on ARNI and beta blockers. Over the next 24 h, he developed a vasoplegic shock necessitating multiple vasopressors and a transfer to a tertiary academic centre. With supportive therapy, his vasoplegic shock improved and he was discharged home. Discussion PARADIGM-HF found that the introduction of an ARNI in patients with ambulatory symptomatic HFrEF reduces the risk of death and heart failure hospitalization. Most recently, PIONEER-HF showed that ARNI reduced N-terminal pro-B-type natriuretic peptide levels at 4 and 8 weeks, without significantly different rates of medication-related adverse effects. However, thus far, no clinical trials have examined the role of ARNI in CS. Our case report highlights the risk of vasoplegic shock caused by initiation of ARNI in patients hospitalized with CS especially in whom renal and hepatic impairment is present.

scholarly journals Assessment of Erythropoietin Levels and Some Iron Indices in Chronic Renal Failure and Liver Cirrhosis Patients

1999 ◽  
Vol 15 (4) ◽  
pp. 229-236 ◽  
Author(s):  
Essam Mady ◽  
Gehane Wissa ◽  
Ali Khalifa ◽  
Mahmoud El-Sabbagh
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Chronic Renal Failure ◽  
Binding Capacity ◽  
Hepatic Function ◽  
Renal Anaemia ◽  
Cell Counts ◽  
Iron Binding Capacity ◽  
The Relationship

This study was constructed to investigate the relationship between renal anaemia and erythropoietin (EPO) concentrations in chronic renal failure (CRF) patients and to evaluate the possible role of the liver. Serum EPO levels were measured in blood samples from 20 CRF patients on hemodialysis (HD), 20 liver cirrhosis (LC) patients, 20 patients having both CRF and LC and undergoing HD, and 20 normal control subjects. Blood cell counts, iron indices (iron, total iron-binding capacity (TIBC) and ferritin), renal function (blood urea nitrogen (BUN) and creatinine), hepatic function (ALT, AST, ALP and bilirubin) investigations were carried out for all the subjects enrolled in this study. CRF patients without LC had serum EPO concentration of 6.21 ± 0.53 mU/ml (mean ± SE), which was significantly higher than that in patients having both CRF and LC (4.32 ± 0.52) (p < 0.01). Both groups showed significantly lower values than the controls (12.75 ± 0.70) (p < 0.001). LC patients with intact kidneys had significantly higher EPO level (22.70 ± 1.70) (p < 0.001). No correlation was found between EPO level and any of the hematologic or iron indices.

scholarly journals Serum Lipoprotein (a) Levels in Chronic Renal Failure and Liver Cirrhosis Patients. Relationship with Atherosclerosis

1999 ◽  
Vol 15 (4) ◽  
pp. 237-247 ◽  
Author(s):  
Essam Mady ◽  
Gehane Wissa ◽  
Ali Khalifa ◽  
Mahmoud El-Sabbagh
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Liver Cirrhosis ◽  
Chronic Renal Failure ◽  
Total Bilirubin ◽  
Hepatic Function ◽  
Serum Lipoprotein ◽  
Lipoprotein A ◽  
The Relationship

This study was carried out to investigate the relationship between lipoprotein (a) levels and the development of atherosclerosis in chronic renal failure (CRF) patients with the possible role of the liver. Serum Lp (a) levels were measured in samples from 20 CRF patients on hemodialysis (HD), 20 liver cirrhosis (LC) patients, 20 patients having both CRF and LC and undergoing HD, and 20 normal control subjects. Renal function (blood urea nitrogen (BUN) and creatinine), hepatic function (transaminases (ALT and AST), alkaline phosphatase (ALP) and total bilirubin) investigations and serum cholesterol were carried out for all the subjects enrolled in this study. Serum Lp (a) concentration in CRF patients without LC was 87.25 ± 6.17 mg/dl, which was significantly higher than all the investigated groups (P < 0.001). Lp(a) concentration in patients with both CRF and LC was 24.65 ± 1.98 mg/dl, which was not significantly different from the controls, but was significantly higher than that in the subjects with LC only (P < 0.001) where the latter group had significantly low Lp (a) values (11.1 ± 0.99) relative to all the other groups (P < 0.001). Lp (a) correlated positively with cholesterol in all groups except the LC subjects, but did not correlate with age, or renal function in both CRF groups.

Komplikationen der Leberzirrhose – medikamentöse versus interventionelle Therapie

2019 ◽  
Vol 144 (18) ◽  
pp. 1259-1266
Author(s):  
Lukas Sturm ◽  
Martin Rössle ◽  
Michael Schultheiß
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Variceal Bleeding ◽  
Hepatorenal Syndrome ◽  
Beta Blockers ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Refractory Ascites ◽  
Effective Therapeutic Option ◽  
Intrahepatic Portosystemic Shunt

AbstractThe prognosis of patients with liver cirrhosis is impaired by complications such as variceal bleeding, ascites, hepatorenal syndrome, hepatic encephalopathy and hepatocellular carcinoma. A steadily increasing array of treatment options for these complications is available, including pharmaceutical treatment (e. g. beta blockers for varices or diuretics for ascites), endoscopic treatment (e. g. band ligation of varices), radiological interventions (e. g. transjugular shunt, transarterial chemoembolization) and liver transplantation. Most of the complications occur due to portal hypertension. Therefore, decompressive treatment by implantation of a transjugular intrahepatic portosystemic shunt (TIPS) an effective therapeutic option for many complications of liver cirrhosis. Its main indications are acute and recurrent variceal bleeding in patients with advanced disease as well as refractory ascites. The TIPS does not affect options of abdominal surgery and may therefore be used as a bridge to liver transplantation.

Sign in / Sign up

Export Citation Format

Share Document