New treatments for hepatorenal syndrome

@article{Arroyo2000NewTF,
  title={New treatments for hepatorenal syndrome},
  author={Vicente Arroyo},
  journal={Liver Transplantation},
  year={2000},
  volume={6}
}
  • V. Arroyo
  • Published 1 May 2000
  • Medicine
  • Liver Transplantation

Topics from this paper

The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records
TLDR
Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population and demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality.
Acute kidney injury in children with chronic liver disease
TLDR
The pathophysiological basis, treatment modalities and controversies in the diagnosis and treatment of AKI in pediatric patients with chronic liver disease are explored and the focus here on HRS is focused on.
Updates on hepatorenal syndrome and strategies bridging to liver transplantation
TLDR
This review focuses on the different strategies to bridge patients to liver transplantation and to improve the postoperative outcome.
Insuffisance rénale aigüe chez le patient cirrhotique : particularités diagnostiques et thérapeutiques
TLDR
A specific definition of acute renal injury in cirrhosis is identified, its prevalence and main causes are estimated, and a diagnostic and therapeutic approach is proposed to the patient with Cirrhosis and acute renal failure is proposed.
Circulating nitric oxide products do not solely reflect nitric oxide release in cirrhosis and portal hypertension
TLDR
Patients with cirrhosis often develop a systemic vasodilatation and a hyperdynamic circulation with activation of vasoconstrictor systems such as the renin–angiotensin–aldosterone system (RAAS), and vasopressin including increased exhaled NO concentrations.
Medical Management of Chronic Liver Diseases (CLD) in Children (Part II)
TLDR
Once hepatorenal syndrome is suspected, treatment should be initiated early in order to prevent the progression of renal failure; approaches consist of general supportive measures, management of concomitant complications, screening for sepsis, treatment with antibiotics, use of vasopressin analogs (terlipressin), and renal replacement therapy if needed.
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.
TLDR
There is a clear rationale for the management of ascites in patients with cirrhosis, as successful treatment may improve outcome and symptoms, and patients with ascites should generally be considered for referral for liver transplantation.
Renal failure in patients with cirrhosis: hepatorenal syndrome and renal support strategies
TLDR
Hepatorenal syndrome, HRS, is a diagnosis of exclusion and it is imperative to maintain euvolemia and hemodynamics in this patient population to optimize renal perfusion and preserve renal function.
Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality
TLDR
ARF at admission or during ICU stay is strongly predictive of mortality, which is high, despite supportive therapeutic interventions, and preventive measures are needed to prevent ARF, to improve prognosis.
Degree of hepatic dysfunction and improvement of renal function predict survival in patients with HRS type I: a retrospective analysis
TLDR
The data of this large monocentric series with HRS type I confirm the poor prognosis in these patients, especially in those with high Child–Pugh and MELD scores, and in those in whom kidney function does not improve within 2 weeks.
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References

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Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome: a pilot study.
TLDR
Long-term terlipressin administration is safe and effective to control type 1 HRS, however, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.
Risk factors for the development of renal dysfunction in hospitalized patients with cirrhosis.
TLDR
Risk factors for the development of renal dysfunction in hospitalized patients with cirrhosis and how these factors are changed over time are investigated.
Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial
  • S. Mitzner, J. Stange, +14 authors R. Schmidt
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2000
TLDR
It is concluded that the removal of albumin‐bound substances with the MARS method can contribute to the treatment of type I HRS.
Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.
TLDR
Treatment with PTX improves short-term survival in patients with severe alcoholic hepatitis and appears to be related to a significant decrease in the risk of developing hepatorenal syndrome.
Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome.
TLDR
Terrlipressin associated with albumin appears to be a safe and effective treatment of hepatorenal syndrome.
Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.
TLDR
In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.
Long‐term therapy and retreatment of hepatorenal syndrome type 1 with ornipressin and dopamine
TLDR
Evaluating the therapeutic potential of the vasoconstrictor ornipressin plus dopamine in the treatment of the most severe form of HRS type 1 found it can be a useful therapeutic option in patients with H RS type 1, especially as bridge to liver transplantation.
Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide
TLDR
The long‐term administration of midodrine and octreotide seems to be an effective and safe treatment of type 1 HRS in patients with cirrhosis.
Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion
TLDR
The decrease in effective arterial blood volume and the activation of vasoconstrictor systems play a crucial role in the pathogenesis of hepatorenal syndrome.
Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems
TLDR
In conclusion, TIPS improves renal function and reduces the activity of the renin‐angiotensin and sympathetic nervous systems in cirrhotic patients with type I HRS.
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