Renal Complications of Liver Disease and the Hepatorenal Syndrome

2017 ◽  
pp. 336-352
Author(s):  
Xingxing S. Cheng ◽  
W. Ray Kim
Keyword(s):  
Liver Disease ◽  
Hepatorenal Syndrome ◽  
Renal Complications

scholarly journals End‐stage liver disease: Management of hepatorenal syndrome

2021 ◽  
Vol 41 (S1) ◽  
pp. 119-127
Author(s):  
Ezequiel Mauro ◽  
Lucrecia Garcia‐Olveira ◽  
Adrián Gadano ◽  
Luca Valenti
Keyword(s):  
Liver Disease ◽  
Disease Management ◽  
Hepatorenal Syndrome ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Is MELD score failing patients with liver disease and hepatorenal syndrome?

2016 ◽  
Vol 8 (27) ◽  
pp. 1155 ◽  
Author(s):  
Lena Sibulesky ◽  
Nicolae Leca ◽  
Christopher Blosser ◽  
Amir A Rahnemai-Azar ◽  
Renuka Bhattacharya ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatorenal Syndrome ◽  
Meld Score

scholarly journals Hepatorenal Syndrome: Physiology, Diagnosis and Management

2018 ◽  
Vol 35 (03) ◽  
pp. 194-197 ◽  
Author(s):  
Joseph Chmielewski ◽  
Robert Lewandowski ◽  
Haripriya Maddur
Keyword(s):  
Liver Disease ◽  
Hepatorenal Syndrome ◽  
Hepatic Dysfunction ◽  
Underlying Liver Disease ◽  
Free Survival ◽  
Renal Vasoconstriction ◽  
End Stage Liver Disease ◽  
Widespread Implementation ◽  
Intrahepatic Portosystemic Shunt ◽  
End Stage

AbstractIndividuals with end-stage liver disease are susceptible to a myriad of highly morbid complications, including hepatorenal syndrome (HRS). This specific type of renal dysfunction in patients with underlying liver disease occurs in pathophysiologically normal kidneys and is a result of renal vasoconstriction secondary to diminished renal blood flow in the setting of worsening hepatic dysfunction. Liver transplantation is curative; shortage of available organs limits access to this beneficial therapy. Medical management of HRS has demonstrated increasing promise. Transjugular intrahepatic portosystemic shunt creation has also been shown to be efficacious in enhancing transplant-free survival, although further study is advisable before widespread implementation of this strategy.

Targeting the gut-liver-immune axis to treat cirrhosis

Gut ◽  
2020 ◽  
pp. gutjnl-2020-320786 ◽  
Author(s):  
Thomas Henry Tranah ◽  
Lindsey A Edwards ◽  
Bernd Schnabl ◽  
Debbie Lindsay Shawcross
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Bacterial Infections ◽  
Hepatorenal Syndrome ◽  
Intestinal Barrier ◽  
Chronic Liver ◽  
Decompensated Cirrhosis ◽  
Barrier Dysfunction ◽  
Bacterial Peritonitis ◽  
Gut Barrier Function

Cirrhotic portal hypertension is characterised by development of the decompensating events of ascites, encephalopathy, portal hypertensive bleeding and hepatorenal syndrome, which arise in a setting of cirrhosis-associated immune dysfunction (CAID) and define morbidity and prognosis. CAID describes the dichotomous observations that systemic immune cells are primed and display an inflammatory phenotype, while failing to mount robust responses to pathogen challenge. Bacterial infections including spontaneous bacterial peritonitis are common complications of advanced chronic liver disease and can precipitate variceal haemorrhage, hepatorenal syndrome and acute-on-chronic liver failure; they frequently arise from gut-derived organisms and are closely linked with dysbiosis of the commensal intestinal microbiota in advanced chronic liver disease.Here, we review the links between cirrhotic dysbiosis, intestinal barrier dysfunction and deficits of host-microbiome compartmentalisation and mucosal immune homoeostasis that occur in settings of advanced chronic liver disease. We discuss established and emerging therapeutic strategies targeted at restoring intestinal eubiosis, augmenting gut barrier function and ameliorating the mucosal and systemic immune deficits that characterise and define the course of decompensated cirrhosis.

The Hepatorenal Syndrome

1997 ◽  
Vol 92 (5) ◽  
pp. 433-443 ◽  
Author(s):  
Kevin Moore
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
Liver Disease ◽  
Renal Blood Flow ◽  
Hepatorenal Syndrome ◽  
Venous Pressure ◽  
Renal Perfusion ◽  
Filtration Fraction ◽  
Renal Vasoconstriction ◽  
Vasoactive Mediators

1. The hepatorenal syndrome is the development of renal failure in patients with severe liver disease in the absence of any identifiable renal pathology. 2. Decreased glomerular filtration is caused by a reduction in both renal blood flow and the renal filtration fraction. These changes arise as a consequence of a fall in mean arterial pressure due to systemic vasodilatation, activation of the sympathetic nervous system causing renal vasoconstriction, and increased synthesis of several vasoactive mediators, which together modulate both renal blood flow and the glomerular capillary ultrafiltration coefficient, and thence filtration fraction. 3. Patients with liver disease developing renal failure should have hypovolaemia excluded by volume challenge, and all nephrotoxic drugs including diuretics should be stopped. Broad-spectrum antibiotics should be given for subclinical infection, which may be a treatable precipitant of renal failure in cirrhosis. Renal perfusion should be optimized by ensuring that the blood pressure and systemic haemodynamics are adequate, and that if renal venous pressure is elevated, due to tense ascites, it is alleviated. 4. The prognosis of hepatorenal syndrome is poor with a >90% mortality. However, patients can and do recover from the hepatorenal syndrome, but only if there is a significant improvement of their liver function, or if they undergo liver transplantation.

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