Effects of lumbar sympathetic block on kidney function in cirrhotic patients with hepatorenal syndrome

Solı́s-Herruzo, José A.; Duran, Ayşe Ocak; Favela, V.; Castellano, Giancarlo; Madrid, J.L.; Muñoz-Yagüe, M. T.; Morillas, Juan Diego; Estenoz, J.

doi:10.1016/s0168-8278(87)80569-x

Cited by 108 publications

(46 citation statements)

References 29 publications

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“…It has been shown that the direct inhibition of renal sympathetic nerve activity by anesthetic blockade of renal sympathetic innervation is associated with a marked increase in GFR in cirrhotic patients with HRS. 50 However, after direct renal sympathetic inhibition, there is a rapid increase in GFR, whereas the improvement of GFR after TIPS in our patients occurred very slowly. Further studies are needed to elucidate the mechanism(s) by which TIPS improves renal function in patients with HRS.…”

Section: Discussioncontrasting

confidence: 51%

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Guevara¹,

Ginès²,

Bandi³

et al. 1998

Hepatology

387

202

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Little information exists on the effects of transjugular intrahepatic portosystemic shunts (TIPS) in the management of cirrhotic patients with hepatorenal syndrome (HRS). The current study was aimed to prospectively evaluate the effects of TIPS on renal function and vasoactive systems in patients with type I HRS. Glomerular filtration rate (GFR) (inulin clearance), renal plasma flow (RPF) (para-aminohippurate clearance), plasma renin activity (PRA), aldosterone (ALDO), norepinephrine (NE), and endothelin (ET) were determined in baseline conditions and at different time intervals after TIPS in 7 patients with type I HRS. TIPS induced a marked reduction of portal pressure gradient (PPG) (20 ؎ 1 to 10 ؎ 1 mm Hg; P F .05). Renal function improved in 6 of the 7 patients. Serum creatinine and blood urea nitrogen (BUN) decreased from 5 ؎ 0.8 and 109 ؎ 7 to 1.8 ؎ 0.4 mg/dL and 56 ؎ 11 mg/dL, respectively (P F .05 for both), and GFR and RPF increased from 9 ؎ 4 and 103 ؎ 33 to 27 ؎ 7 mL/min and 233 ؎ 40 mL/min, respectively (P F .05 for both), 30 days after TIPS. These beneficial effects on renal function were associated with a significant (P F .05) reduction of PRA (18 ؎ 5 to 3 ؎ 1 ng/mL · h), ALDO (279 ؎ 58 to 99 ؎ 56 ng/dL), and NE (1,257 ؎ 187 to 612 ؎ 197 pg/mL). ET did not change significantly (28 ؎ 8 to 27 ؎ 11 pg/mL). Mean survival was 4.7 ؎ 2 months (0.3-17 months). Three patients remained alive more than 3 months after TIPS insertion. 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. Nevertheless, the efficacy of TIPS in the management of these patients should be confirmed in controlled investigations. (HEPATOLOGY 1998;28:416-422.)Hepatorenal syndrome (HRS) is a common and severe complication of patients with advanced cirrhosis and is characterized by renal failure, marked portal hypertension, abnormalities in the arterial circulation, and overactivity of endogenous vasoactive systems. [1][2][3][4][5] Up to now, the only treatment that has been shown to improve survival in patients with HRS is liver transplantation. 3-7 However, because of the short survival of patients with HRS and the limited availability of organs, only a small percentage of patients with HRS can actually reach transplantation. Therefore, it would be of great value to have a therapeutic method that could improve renal function and increase survival, especially in patients with type I HRS, which is characterized by a rapid progression of renal failure and a very short survival expectancy. 3 The transjugular intrahepatic portosystemic shunt (TIPS) has been introduced recently in clinical practice for the management of cirrhotic patients with variceal bleeding. 8,9 As with surgical portosystemic shunts, the use of TIPS is associated with a marked reduction in portal pressure but with the advantage of a very low operative morbidity and mortality. It has been shown that TIPS is useful in the management of acute variceal hemorrhage th...

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Section: Discussioncontrasting

confidence: 51%

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Guevara¹,

Ginès²,

Bandi³

et al. 1998

Hepatology

387

202

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“…Support for this concept in humans comes from the studies by Jalan et al (31), who demonstrated acute reduction in RBF in a patient with cirrhosis after acute transjugular intrahepatic shunt insertion (TIPS) occlusion. In another study, lumbar sympathectomy increased GFR in five patients with HRS and GFR Ͻ25 ml/min but not in three others with GFR Ͼ25 ml/min, suggesting that renal sympathetic nerve activity contributes to renal vasoconstriction in a selected group of patients with HRS (32). Hence, the current evidence is lacking a primary role for hepatorenal or splenorenal reflex in HRS in humans.…”

Section: Stimulation Of the Renal Snsmentioning

confidence: 78%

Hepatorenal Syndrome

Wadei

Martin

Ahsan

et al. 2006

Clinical Journal of the American Society of Nephrology

229

194

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“…Several investigations performed during the 1960s and 1970s have shown that the kidney SNS, partially reverses renal dysfunction in patients with HRS. 52 ADH may also contribute to circulating blood volume is markedly increased in cirrhotic patients with and without ascites, and signifirenal vasoconstriction because plasma ADH levels correlate inversely with renal blood flow and GFR. 42 Fi-cant sodium retention precedes the development of ascites in experimental models of cirrhosis.…”

Section: In Medicinementioning

confidence: 99%

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis†

Arroyo¹,

Ginès²,

Gerbes³

et al. 1996

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During the last decade great advances have been made of water retention and dilutional hyponatremia in human cirrhosis. Finally, the field of spontaneous infection of concerning the pathogenesis and treatment of ascites. A new hypothesis on the mechanism of renal dysfunction ascitic fluid (spontaneous bacterial peritonitis) is also experiencing major changes. The demonstration of intestiand ascites formation in cirrhosis has been proposed 1 and this has greatly stimulated research in this area. The nal bacterial translocation in experimental models of cirrhosis, 12 the potential role of cytokines in some discovery of the important role played by the vascular endothelium in the homeostasis of systemic hemodynam-complications associated with this infection, 13 the identification of subgroups of cirrhotic patients predisposed to ics and renal function 2,3 has also opened an important field of research into pathophysiology, and evidence has develop spontaneous bacterial peritonitis, 14 and the effectiveness of selective intestinal decontamination in the been presented implicating endothelial factors in the pathogenesis of systemic circulatory dysfunction in cir-primary and secondary prophylaxis of spontaneous bacterial peritonitis 15,16 are the most relevant developments. rhosis 4,5 and hepatorenal syndrome (HRS). 6 The reintroduction of therapeutic paracentesis has greatly modifiedIn clear contrast to these advances, little attention has been paid to the standardization of the nomenclathe treatment of cirrhotic patients with tense or refractory ascites. 7 The transjugular intrahepatic portosys-ture and diagnostic criteria of different syndromes associated with ascites in cirrhosis. The existence of a temic shunt is another therapeutic tool of potential interest in the management of refractory ascites. 8 The uniform language, however, is essential in modern medicine. It facilitates communication among clinisynthesis of orally-active specific antagonists of the tubular effect of antidiuretic hormone and inhibitors of antidi-cians and researchers and ensures unambiguous diagnoses and more confident prognoses. Moreover, it uretic hormone release will probably add new drugs to the pharmacological armamentarium for patients with improves pathophysiological and therapeutic investigations, simplifies the analysis of therapeutic trials, cirrhosis and ascites. These ''aquaretic drugs,'' which normalize renal water metabolism in experimental cirrhosis and stimulates multicenter studies. and ascites, 9-11 are of potential interest for the treatment PREVIOUS CONSENSUS DEFINITIONS OF HEPATORENAL SYNDROME AND

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Effects of lumbar sympathetic block on kidney function in cirrhotic patients with hepatorenal syndrome

Cited by 108 publications

References 29 publications

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Hepatorenal Syndrome

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis†

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