An Integrated Review of the Hepatorenal Syndrome

Ojeda-Yuren, Alicia Sarahi; Cerda-Reyes, Eira; Herrero-Maceda, M.R.; Castro-Narro, Graciela; Piano, Salvatore

doi:10.1016/j.aohep.2020.07.008

Cited by 31 publications

(26 citation statements)

References 43 publications

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“…The pathophysiology of HRS-AKI is multifactorial and mostly attributed to an uncompensated hyperdynamic circulatory system, renal vasoconstriction and systematic inflammation [ 9 , 10 , 11 ]. The diagnosis of HRS-AKI is often demanding and complex due to the clinical challenge of differentiating between HRS-AKI and other causes of AKI (such as pre-renal azotemia and acute tubular necrosis (ATN)).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury

Sasso

Yassine

Deeb

2021

JCM

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Hepatorenal syndrome (HRS) is a type of acute kidney injury (AKI), occurring in patients with decompensated liver cirrhosis and is associated with high mortality. We aim to describe the predictors associated with the development of HRS in cirrhotic patients with AKI. We retrospectively analyzed 529 cirrhotic patient encounters with AKI across all Northwell Health institutions between 1 January 2015 and 31 December 2018. We performed multivariate analyses to determine independent predictors of development of HRS. Alcoholic cirrhosis was the most common identified etiology of cirrhosis. The mean Model for End-Stage Liver Disease Scorewas18 (±7). Ascites was the most commonly identified clinical feature of portal hypertension. Infection was identified in 38.4% of patients with urinary tract infection/pyelonephritis being the most common. Spontaneous bacterial peritonitis occurred in 5.9% of patients. The most common cause of AKI was pre-renal. Hepatorenal syndrome was identified in 9.8% of patient encounters. Predictors of HRS were history of ascites, serum creatinine >2.5 mg/dL, albumin <3 g/dL, bilirubin >2 mg/dL and spontaneous bacterial peritonitis. We demonstrate strong predictors for the development of HRS which can aid clinicians to attain an early diagnosis of HRS, leading to prompt and targeted management and improving outcomes.

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Section: Introductionmentioning

confidence: 99%

Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury

Sasso

Yassine

Deeb

2021

JCM

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“…All vasoconstrictors should be combined with albumin 114 . These drugs augment systolic blood pressure and arterial volume, increasing renal perfusion, producing systemic and splanchnic vasoconstriction 115 .…”

Section: Acute Kidney Injury -Hepatorenal Syndrome (Aki-hrs) Preventi...mentioning

confidence: 99%

Current Medical Treatment for Alcohol-Associated Liver Disease

Ayares

Idalsoaga

Díaz

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…This is supported by the fact that a lower percentage of patients received a liver transplant within 90 days in the terlipressin group compared with the placebo group (23% versus 29%) with no difference in Model for End-stage Liver Disease scores between both groups. Liver transplantation is the definitive treatment for HRS (10), and other pathways of treatment, including vasopressors and plasma expanders, are generally used to bridge patients to liver transplantation. Using a treatment regimen that could potentially induce serious adverse events precluding liver transplantation is clearly a significant material risk that would need to be disclosed to patients.…”

Section: The Unattractivementioning

confidence: 99%