Current management and novel therapeutic strategies for refractory ascites and hepatorenal syndrome

Suzuki, H; Stanley, AJ

doi:10.1093/qjmed/94.6.293

Cited by 16 publications

(11 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…RA is known to carry a poor prognosis, with a 1 year transplant‐free survival in advanced cirrhotic patients of 20–50% (2). Patients with RA usually have additional complications, including spontaneous bacterial peritonitis, hepatorenal syndrome and hepatic hydrothorax (3–4). Large volume paracentesis (LVP), a transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunts and portocaval shunts have all been used (1–9) in treating patients with RA.…”

Section: Introductionmentioning

confidence: 99%

Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

Nishida¹,

Gaynor²,

Nakamura

et al. 2006

American Journal of Transplantation

View full text Add to dashboard Cite

A retrospective study of 1058 liver transplant recipients was performed to determine: (i) the incidence, etiology, timing, clinical features and treatment of refractory ascites (RA), (ii) risk factors for RA development, (iii) predictors of RA disappearance, (iv) predictors of survival following RA and (v) the impact of RA on patient survival. Sixty-two patients (5.9%) developed RA and its disappearance occurred in 27/62 cases. Patients having hepatitis C virus (HCV) had a significantly higher hazard rate of developing RA (p < 0.00001). No other baseline characteristic was associated with RA. Cox stepwise regression analysis of the hazard rate of RA disappearance found two significant factors: HCV recurrence as the reason for developing RA implied a poorer outcome (p = 0.006), whereas an unknown reason implied a favorable outcome (p = 0.02). In addition, survival following RA was significantly poorer among patients having bacterial peritonitis or HCV recurrence. Finally, the mortality rate was significantly (nearly 8.6 times) higher in patients following RA development while it was ongoing (p < 0.00001); however, if the RA disappeared, then the additional risk of death also disappeared. This study illustrates the importance of developing an optimal treatment strategy to (i) effectively treat RA if it develops and (ii) prevent hepatitis C recurrence.

show abstract

Section: Introductionmentioning

confidence: 99%

Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

Nishida¹,

Gaynor²,

Nakamura

et al. 2006

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…The diagnosis of "refractory ascites" indicates possible future complications like HRS; International Ascites Club, thus defining this therapeutic situation [19].…”

Section: Treatment Prevention and Initial Treatment Of Hrsmentioning

confidence: 99%

Hepatorenal Syndrome: Diagnosis and Treatment – newsreel –

Petrescu

Mitruţ

Petrescu

et al. 2016

Romanian Journal of Internal Medicine

View full text Add to dashboard Cite

Hepatorenal syndrome (HRS) is defined as renal failure that occurs in the presence of severe acute or chronic liver disease in the absence of underlying renal pathology. Due to the functional nature of the disease and the absence of specific diagnostic markers, HRS diagnosis is determined based on positive criteria associated with excluding other causes of renal failure in patients with liver cirrhosis and ascites. Differentiation from other types of acute or chronic renal disease is extremely difficult and therapeutic options are limited, prophylactic behavior is most appropriate in patients with severe hepatic disease and risk factors for the installation of hepatorenal syndrome.Highlighting all precipitating factors of acute renal insufficiency and therapeutic modalities in order to minimize adverse events is an important step in improving the follow-up of the patients with liver cirrhosis. The prognosis is reserved especially for type 1 HRS. Liver transplantation is the best option for patients without contraindications. The therapies introduced in recent years, such as vasoconstrictor drugs or transjugular intrahepatic portosystemic shunt are effective methods in the renal function improvement.

show abstract

“…5 Retrospective studies have identifi ed HRS in about 17% of the patients with ascites admitted to hospital and in more than 50% of deaths occurring among cirrhotic patients with liver failure. [16][17][18] Some clinical and laboratory fi ndings seem to indicate a greater tendency for HRS onset, among which clear sodium retention, low water depuration, dilutional hyponatremia, and hyposmolarity. There is also an association with absence of hepatomegaly and the presence of undernutrition and esophageal varices.…”

Section: Epidemiologymentioning

confidence: 99%

Hepatorenal syndrome: an update

Genzini

Torricelli

2007

Sao Paulo Med. J.

View full text Add to dashboard Cite

RESUMO Síndrome hepatorrenal: estado atualA síndrome hepatorrenal (SHR) é o desenvolvimento do quadro de insufi ciência renal em pacientes com doença hepática crônica prévia sem evidências clínica ou laboratorial de nefropatia prévia. Atinge até 18% dos pacientes cirróticos com ascite em um ano, chegando a 39% em cinco anos, com uma sobrevida média em torno de duas semanas após estabelecido o quadro. O diagnóstico da SHR baseia-se em critérios clínicos e laboratoriais. Seu aparecimento está relacionado ao mecanismo de formação de ascite, que envolve vasoconstrição e hipofl uxo renal, retenção de água e sódio, aumento do volume plasmático, e conseqüentemente hiperfl uxo no território esplâncnico. Mediadores vasoativos renais e humorais, como a endotelina 1, tromboxano A2 e leucotrienos, estão ainda envolvidos na gênese desta síndrome que culmina com insufi ciência renal funcional. O tratamento preconizado da SHR pode ser farmacológico ou cirúrgico, sendo o transplante de fígado o único efetivo e permanente, com sobrevida de até 60% em quatro anos. Após melhora da função hepática, geralmente há a reversão da insufi ciência renal. O diagnóstico precoce e a rápida terapêutica podem ampliar a expectativa de vida destes hepatopatas enquanto se aguarda o transplante hepático para seu tratamento defi nitivo. PALAVRAS-CHAVE:

show abstract

Current management and novel therapeutic strategies for refractory ascites and hepatorenal syndrome

Cited by 16 publications

References 76 publications

Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

Hepatorenal Syndrome: Diagnosis and Treatment – newsreel –

Hepatorenal syndrome: an update

Contact Info

Product

Resources

About