IMMUNE MECHANISMS FOR THE DEVELOPMENT OF HEPATORENAL SYNDROME IN LIVER CIRRHOSIS

2020 ◽  
pp. 7-19
Author(s):  
Luiza M. Karzakova ◽  
Antonina L. Ivanova ◽  
Sergei I. Kudryashov ◽  
Evgeniya V. Sokolova ◽  
Tatyana S. Lutkova
Keyword(s):  
Innate Immunity ◽  
Liver Cirrhosis ◽  
Inflammatory Reaction ◽  
Hepatorenal Syndrome ◽  
Kidney Damage ◽  
Systemic Inflammatory Reaction ◽  
Life Threatening ◽  
Innate Immunity Cells ◽  
Life Threatening Complication

Hepatorenal syndrome is a life-threatening complication of liver cirrhosis. 90% of patients with liver cirrhosis die within 2 months since the onset of hepatorenal syndrome development. For many years the hypothesis of the hemodynamic mechanism of hepatorenal syndrome development was accepted as the only true one, according to this hypothesis compensatory systemic vasodilation in response to portal hypertension causes renal ischemia and the development of functional specific acute kidney damage, the so-called “hepatorenal syndrome – acute kidney damage”. In recent years some works were published that substantiate the role of a systemic inflammatory reaction in the development of hepatorenal syndrome; this inflammatory reaction being associated with activation of innate immunity cells in response to a bacterial infection, including that to the microflora of the intestine which is adjacent to the liver. Data has been obtained which indicated that Toll-like receptors (TLRs), in particular TLR4 and TLR9 are involved in the development of hepatorenal syndrome.

scholarly journals Prevalence of Acute Kidney Injury in Patients with Liver Cirrhosis

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Pukar Thapa ◽  
Sudhamshu KC ◽  
Achyut Bikram Hamal ◽  
Dilip Sharma ◽  
Sandip Khadka ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Cirrhosis ◽  
Hospital Stay ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Tubular Necrosis ◽  
Advanced Liver Cirrhosis ◽  
Life Threatening

Introduction: Acute kidney injury is a common and life-threatening event in patients with liver cirrhosis occurring in approximately 20-50% of hospitalized patients of liver cirrhosis. Pre-renal acute kidney injury, the hepatorenal syndrome type of acute kidney injury and acute tubular necrosis represent the common causes. The aim of this study was to study the profile of acute kidney injury in patients with liver cirrhosis. Methods: Consecutive patients of liver cirrhosis admitted in Liver unit of Bir Hospital were studied to see the presence of acute kidney injury in this hospital based descriptive cross-sectional study. Clinical and laboratory parameters along with various clinical outcome were compared between different groups categorized by the severity of liver disease and renal dysfunction. Results: Out of 302 liver cirrhosis patients, 56 (18.5%) had acute kidney injury among which 23 (46%) were found to have pre-renal acute kidney injury, 15 (30%) with hepatorenal syndrome– acute kidney injury and 12 (24%) with intrinsic renal disease. Patients with higher stages of acute kidney injury had longer duration of hospital stay and hepatorenal syndrome-acute kidney injury was seen in patients with higher grade of ascites and with hyponatremia. Conclusions: Acute kidney injury is a common occurrence in patients with advanced liver cirrhosis with pre-renal acute kidney injury being the commonest cause. Median hospital stay is directly affected by the severity of acute kidney injury and hepatorenal syndrome–acute kidney injury was seen in patients with higher grade of ascites and hyponatremia. Early identification of patients at high risk for acute kidney injury may help to reduce mortality and contain costs.  

scholarly journals The use of vasoconstrictors in patients with liver cirrhosis: how, when, why

2012 ◽  
Vol 6 (3) ◽  
pp. 105-115
Author(s):  
Claudio Puoti
Keyword(s):  
Blood Flow ◽  
Liver Cirrhosis ◽  
Hepatorenal Syndrome ◽  
Portal Blood Flow ◽  
Decompensated Cirrhosis ◽  
Enos Activity ◽  
Enhanced Production ◽  
Massive Gastrointestinal Bleeding ◽  
No Release

Portal hypertension (PH) is a severe complication of liver cirrhosis. Patients with PH run the risk of developing gastro-esophageal varices and massive gastrointestinal bleeding, ascites, hepatorenal syndrome, and hepatic encephalopathy. Portal blood flow in its turn increases because of enhanced production of vasodilators, increased eNOS activity and NO release, systemic and splanchnic vasodilation, hyperkinetic circulation, and hyposensitivity to vasoconstrictors. Thus, it is now widely recognized that this hyperkinetic (hyperdynamic) circulation that characterizes liver cirrhosis is the main cause of the complications of the disease. This review is aimed at addressing the role of vasoconstrictor treatment in patients suffering from complications of decompensated cirrhosis, offering practical suggestions for the management of this treatment at bedside. In particular, the management of terlipressin in patients with cirrhosis, its side effects and the efficacy of this vasoconstrictor will be examined.

The significance of Toll-like receptors in selected nephropathies

2019 ◽  
Vol 55 (2) ◽  
pp. 107-112
Author(s):  
Sebastian Mertowski ◽  
Ewelina Grywalska ◽  
Jarosław Ludian ◽  
Agnieszka Grafka ◽  
Barbara Pęksa ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Inflammatory Reaction ◽  
Inflammatory Mediators ◽  
Modern Society ◽  
Kidney Damage ◽  
Toll Like Receptors ◽  
Molecular Patterns ◽  
Stimulation Of

The diseases associated with kidney damage are an increasingly common problem in modern society and complications of chronic renal failure can result in death. Research conducted by many scientific centers, both Polish and foreign, concern the search for possible factors involved in the pathogenesis of glomerulonephritis. One of the possible causes of nephropathy may include the dysfunction of Toll-like receptors (TLRs), which constitute a “bridge” between innate and acquired response. TLRs are involved in receiving signals related to pathogen associated molecular patterns (PAMPs) as well as receiving information related to the danger associated molecular patterns (DAMP). The stimulation of these receptors activates a cascade of reactions in the course of which various mediators, including pro-inflammatory mediators, are produced. The resulting long-lasting inflammation that develops within the glomerulus may cause kidney damage. In both nephropathies caused by excessive production of antibodies in the IgA class, as well as nephropathy induced by diabetes or lupus, the expression of individual TLRs may indicate an inducer of an inflammatory reaction cascade that leads to kidney damage. This article focuses on literature reports that present current views on the role of TLRs in the pathogenesis of the most common nephropathies.

scholarly journals Role of Systemic Inflammatory Reaction in Female Genital Organ Malignancies – State of the Art

2021 ◽  
Vol Volume 13 ◽  
pp. 5491-5508
Author(s):  
Michal Mleko ◽  
Kazimierz Pitynski ◽  
Elzbieta Pluta ◽  
Aleksandra Czerw ◽  
Katarzyna Sygit ◽  
...  
Keyword(s):  
Inflammatory Reaction ◽  
State Of The Art ◽  
Genital Organ ◽  
Systemic Inflammatory Reaction ◽  
Female Genital

scholarly journals Systemic Inflammatory Reaction to Intravitreal Bevacizumab: A Case Report

2021 ◽  
Author(s):  
Samuel Burridge ◽  
Richard Stratton ◽  
Riaz Asaria
Keyword(s):  
Adverse Effects ◽  
Inflammatory Reaction ◽  
Intravitreal Bevacizumab ◽  
Case Presentation ◽  
Blood Tests ◽  
Bevacizumab Treatment ◽  
Systemic Inflammatory Reaction ◽  
Life Threatening ◽  
History Of ◽  
Systemic Side Effects

Abstract IntroductionTo present a case of systemic inflammatory reaction, with associated pleural and pericardial effusions, following intravitreal bevacizumab for retinal macroaneurysm. Case presentationA 73 year old female was commenced on monthly intravitreal bevacizumab injections for right eye macroaneurysm and associated macular oedema. Eight days following her third injection, the patient was admitted to hospital with a history of fever, rigors, arthralgia and vomiting. Admission blood tests demonstrated mild thrombocytopaenia and raised inflammatory markers. A CT chest revealed small pericardial and pleural effusions. The patient improved without treatment and was later discharged from hospital. As intravitreal bevacizumab treatment continued, the patient developed two further episodes of fever and vomiting, with both episodes occurring approximately nine days following each injection. The patient then underwent outpatient medical review by infectious disease and rheumatology specialists, at which time the recurrent episodes of systemic inflammation were diagnosed as secondary to intravitreal bevacizumab.ConclusionsThough rare, patients can develop serious and potentially life-threatening systemic adverse effects from intravitreal anti-VEGF treatment. Ophthalmologists should always enquire about systemic side effects; in this way, adverse effects may be recognised sooner and a change or cessation of therapy considered.

scholarly journals Fulminant hepatorenal syndrome due to Acetaminophen toxicity: A case report

2021 ◽  
Author(s):  
Zahra Nekoukar ◽  
Minoo Moghimi ◽  
Zakaria zakariaei ◽  
Mahdi Fakhar ◽  
Rabeeh Tabaripour
Keyword(s):  
Liver Transplantation ◽  
Case Report ◽  
Metabolic Acidosis ◽  
Hepatorenal Syndrome ◽  
Severe Metabolic Acidosis ◽  
Acetaminophen Toxicity ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
High Doses

Hepatorenal syndrome is a rare life-threatening complication of acetaminophen toxicity. It is not responsive to fluid therapy and need performing an emergent liver transplantation. Here, we introduce a 24-year-old woman with a history of chronic high doses of acetaminophen consumption, presenting with nausea, vomiting, lethargy, oliguria, and severe metabolic acidosis.

scholarly journals Role of innate immunity in tolerance induction

2015 ◽  
Vol 61 (5) ◽  
pp. 560-578
Author(s):  
M.S. Dolgikh
Keyword(s):  
Innate Immunity ◽  
Dendritic Cells ◽  
Transplant Rejection ◽  
Tolerance Induction ◽  
Transplant Tolerance ◽  
Innate Immunity Cells ◽  
Tolerogenic Dc

This review considers the role of innate immunity in mechanisms of transplant tolerance and rejection, analyse the role of innate immunity cells (dendritic cells-DC, NK, must and other cells) in these processes, and the pathes of creation of tolerogenic DC for transplant rejection therapy and tolerance.

scholarly journals The Role of Thoracic Ultrasound in Diagnosing Pneumothorax

2019 ◽  
Vol 38 (4) ◽  
pp. 239-43
Author(s):  
Mia Elhidsi ◽  
Budhi Antariksa ◽  
Dianiati Kusumo Sutoyo
Keyword(s):  
Gold Standard ◽  
Thoracic Ultrasound ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
Life Threatening Complication ◽  
B Lines ◽  
Lung Sliding ◽  
Lung Point

Diagnosis of a pneumothorax in some cases the can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. In this situation, thoracic sonography for pneumothorax can be especially helpful, allowing a method of quickly ruling out this potentially life-threatening complication. Its sensitivity dan specificity of ultrasound is higher than conventional chest x-ray. The four sonograms useful to diagnose pneumothorax and their usefulness in ruling in and ruling out the condition are lung sliding, lung pulse, B-lines and lung point. (J Respir Indo. 2018; 38: 239-43)

Suppurative Thrombophlebitis in Childhood

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 630-632
Author(s):  
Nicholas Sears ◽  
Jay L. Grosfeld ◽  
Thomas R. Weber ◽  
Martin B. Kleiman
Keyword(s):  
Surgical Management ◽  
Inflammatory Reaction ◽  
Early Recognition ◽  
Intravenous Therapy ◽  
Intravenous Catheter ◽  
Life Threatening ◽  
Life Threatening Complication

Thrombophlebitis in children is almost always related to intravenous therapy. In most cases the inflammatory reaction is self-limited and resolves when the intravenous catheter or needle is removed. In some cases contamination may result in suppurative thrombophlebitis, a potentially life-threatening complication of intravenous therapy. This report describes two 6-year-old children with suppurative thrombophlebitis that was successfully treated by drainage of periphlebitic abscess and excision of the infected vein. Early recognition and prompt surgical management should reduce morbidity and prevent mortality in these cases.

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