Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment

@article{Wong2009MolecularAR,
  title={Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment},
  author={Florence Wong and Nilima Raina and Robert M. A. Richardson},
  journal={Gut},
  year={2009},
  volume={59},
  pages={381 - 386}
}
Background The pathogenetic mechanism of hepatorenal syndrome (HRS) is paradoxical renal vasoconstriction consequent upon systemic and splanchnic arterial vasodilatation. Molecular adsorbent recirculating system (MARS) is a specialised form of dialysis that clears albumin-bound substances, including vasodilators, and therefore can potentially reduce systemic vasodilatation in cirrhosis. Objective To assess the efficacy of MARS in improving systemic and renal haemodynamics in patients with… 
Optimal management of hepatorenal syndrome in patients with cirrhosis
TLDR
New treatments (vasoconstrictors plus albumin, transjugular portosystemic shunt, and molecular adsorbent recirculating system), which were introduced in the past 10 years, are effective in improving renal function in patients with HRS.
Recent advances in our understanding of hepatorenal syndrome
  • F. Wong
  • Medicine
    Nature Reviews Gastroenterology &Hepatology
  • 2012
TLDR
Patients who have had >8–12 weeks of pretransplant dialysis should be considered for combined liver–kidney transplantation and in nonresponders to vasoconstrictor therapy, much controversy still exists as to whether to do simultaneous or sequential liver and kidney transplant.
Blood cytokine, chemokine and gene expression in cholestasis patients with intractable pruritis treated with a molecular adsorbent recirculating system: a case series.
TLDR
The clinical benefit of MARS in cholestasis patients with intractable pruritus may not exclusively result from filtration of pruritogens, but also from systemic changes in cytokine⁄chemokine levels and changes in gene expression of blood cells.
Hepatorenal syndrome: a severe, but treatable, cause of kidney failure in cirrhosis.
  • C. Fagundes, P. Ginès
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2012
TLDR
Pharmacologic treatment with vasoconstrictors to reverse splanchnic vasodilation, together with albumin, is effective in 40%-50% of patients with type 1 HRS and improves survival and the drug of choice is the vasopressin analogue terlipressin.
Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs.
TLDR
Clinical strategies to prevent Hepatorenal syndrome have been improved by a better understanding of the natural history of renal failure in cirrhosis, resulting in a reduction of HRS prevalence in Cirrhotic patients.
Renal Replacement Therapy in Special Settings: Extracorporeal Support Devices in Liver Failure
TLDR
The available evidence regarding the optimal use of ECS devices in HRS is reviewed, evidence‐based practice recommendations are made, and key questions for future studies are delineated.
[Hepatorenal syndrome].
TLDR
Transplantation is the only way to improve the long-term prognosis and the combined use of intravenous albumin, splanchnic and peripheral vasoconstrictor and/or renal replacement therapy sometimes enables a delay until liver transplantation (or combined liver-kidney in selected patients).
Reappraising the spectrum of AKI and hepatorenal syndrome in patients with cirrhosis
TLDR
New insights suggest that non-haemodynamic tubulo-toxic factors, such as endotoxin-mediated inflammation, bile acid-induced tubular toxicity and true tubular ischaemia, are now implicated in the pathogenesis of hepatorenal syndrome type 1 (HRS-1), and renal vasoconstriction and reduced renal blood flow continue to be regarded as the quintessential mechanism of renal dysfunction.
Hepatorenal Syndrome
  • T. Kiser
  • Medicine
    International journal of clinical medicine
  • 2014
TLDR
Tterlipressin with the addition of adjunctive albumin volume expansion is the preferred pharmacologic therapy for the treatment of patients with HRS.
Hepatorenal syndrome
TLDR
This Primer discusses new diagnostic criteria of acute kidney injury in the context of HRS and also covers pathophysiology and management of this serious disorder.
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