Hepatic, splanchnic and systemic haemodynamic abnormalities in portal hypertension

Bosch, Jaime; Pizcueta, M. Pilar; Fernández, Mercedes; Feu, Faust; Cirera, Isabel; Luca, Angelo; García–Pagán, Joan Carles

doi:10.1016/0950-3528(92)90030-i

Cited by 20 publications

(17 citation statements)

References 36 publications

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“…Liver cirrhosis is characterised by a hyperdynamic circulation, with an increased cardiac preload22 and a decreased cardiac afterload 23. For healthy hearts, the diastolic filling of the left ventricle and the systolic emptying would be enhanced under these haemodynamic conditions.…”

Section: Discussionmentioning

confidence: 99%

Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

Huonker

Schumacher

Ochs

et al. 1999

Gut

170

115

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Conclusions-The increase in the left atrial diameter, the pulmonary capillary wedge pressure, and total pulmonary resistance observed after the TIPS procedure reflected diastolic dysfunction of the hyperdynamic left ventricle in patients with alcoholic cirrhosis. The haemodynamic eVects of the portosystemic stent shunt itself on the splanchnic circulation seem to be mainly responsible for the further decrease in systemic vascular resistance. TIPS may unmask a coexisting preclinical cardiomyopathy in patients with alcoholic cirrhosis and portal hypertension. (Gut 1999;44:743-748)

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Section: Discussionmentioning

confidence: 99%

Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

Huonker

Schumacher

Ochs

et al. 1999

Gut

170

115

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“…These authors, however, in a recent publication, found a trend toward augmented natriuresis at 7 days after TIPS insertion. 13 A complex interaction of hemodynamics and neurohumoral systems governs ascites formation [18][19][20][21][22][23][24][25] and must be considered for the renal response to therapy. Regarding the mechanism of TIPS-induced natriuresis, we observed an increase of fractional sodium excretion in patients with refractory ascites.…”

Section: Discussionmentioning

confidence: 99%

Renal effects of transjugular intrahepatic portosystemic shunt in cirrhosis: Comparison of patients with ascites, with refractory ascites, or without ascites

et al. 1998

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Renal effects of the transjugular intrahepatic portosystemic shunt (TIPS) were compared in 6 patients without ascites (group 1), 11 patients with ascites responding to diuretic treatment (group 2), and 6 patients with refractory ascites (group 3). Seven days after insertion of TIPS, 24-hour urinary sodium excretion had increased in patients with ascites: 113 ؎ 16 mmol to 170 ؎ 30 mmol (P ‫؍‬ .012) in group 2, and 22 ؎ 8 mmol to 77 ؎ 27 mmol (P ‫؍‬ .050) in group 3. In group 3, fractional sodium excretion tended to increase from 0.26% ؎ 0.14% to 0.62% ؎ 18% (P ‫؍‬ .081). The relative increase of urinary sodium excretion (to 444% ؎ 122%) and fractional sodium excretion (to 413% ؎ 127%) in group 3 was significantly (P F .05) higher than in group 1 and group 2, respectively. Creatinine clearance and 24-hour urinary volume were not significantly changed in either group. Patients with Child-Pugh class C had a more pronounced effect of TIPS on urinary sodium excretion (increase to 396% ؎ 115% vs. 139% ؎ 15%; P ‫؍‬ .066) and on fractional sodium excretion (increase to 415% ؎ 103% vs. 94% ؎ 15%; P ‫؍‬ .020) than patients with less-severe liver disease. Fractional sodium excretion of less than 0.35% before TIPS was found to be an indicator of renal response to TIPS. The effect of TIPS on urinary sodium excretion and on fractional sodium excretion was related to the patients' Child-Pugh score (r ‫؍‬ .55; P ‫؍‬ .007 and r ‫؍‬ .68; P ‫؍‬ .001, respectively) and inversely to their fractional sodium excretion (r ‫؍‬ Ϫ.44; P ‫؍‬ .047 and r ‫؍‬ Ϫ.54; P ‫؍‬ .012, respectively) before TIPS. These data demonstrate that TIPS affects renal sodium handling in patients with ascites, particularly in patients with refractory ascites. Severity of liver disease and fractional sodium excretion before TIPS are parameters to predict the extent of the renal response. (HEPATOLOGY 1998;28:683-688.)The transjugular intrahepatic portosystemic shunt (TIPS), a nonsurgical side-to-side shunt, has been introduced to prevent variceal rebleeding or to control refractory variceal bleeding by reducing the portal pressure gradient. 1-4 A considerable portion of these patients who had ascites at the time of TIPS insertion reduced the degree of ascites following TIPS. Therefore, patients with refractory or recurrent ascites were treated with TIPS, most of them with remarkable success. [5][6][7][8][9] These observations prompted studies on the effects of TIPS on sodium handling in patients with refractory ascites. Little is known, however, about the effects of TIPS on renal function in patients without ascites or with ascites not refractory to diuretic treatment. Moreover, predictors of renal response to TIPS have not yet been identified. Furthermore, information about the early influence of TIPS on renal function is limited. [6][7][8][9][10][11][12][13] Most of the previous studies were performed without diuretics or with the dose of diuretics decreasing throughout the observation period. While withholding diuretic treatment from those patients does not repr...

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“…The shunting of blood and excess vasodilators from the splanchnic to the systemic circulation following the opening of portal-systemic shunts related to increased portal pressure also leads to systemic arterial vasodilation 16. The combined effect causes a relative inadequacy of the systemic circulation, the so-called ‘reduction in the effective arterial blood volume’, thereby triggering a hyperdynamic circulation in these patients 17 18…”

Section: Pathophysiology Of Hepatorenal Syndromementioning

confidence: 99%

Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis

Wong

Nadim

Kellum

et al. 2011

Gut

370

354

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Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal.

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Hepatic, splanchnic and systemic haemodynamic abnormalities in portal hypertension

Cited by 20 publications

References 36 publications

Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

Renal effects of transjugular intrahepatic portosystemic shunt in cirrhosis: Comparison of patients with ascites, with refractory ascites, or without ascites

Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis

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