Hepatorenal syndrome: pathophysiology, diagnosis, and management

Simonetto, Douglas A.; Ginès, Pere; Kamath, Patrick S.

doi:10.1136/bmj.m2687

Cited by 151 publications

(175 citation statements)

References 152 publications

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“…failure. 5 His blood urea nitrogen and creatinine were 95.5 mg/ dL and 3.16 mg/dL, respectively (figure 8). High concentration of norepinephrine was continuously given and 12.5 g of albumin preparation was infused intravenously.…”

Section: Images In…mentioning

confidence: 96%

Effectiveness of a pleuroperitoneal shunt for refractory hepatic hydrothorax that appeared after ligation of a communicating hydrocele

Nakatsuji

Yoshizawa²,

Ohyama³

2021

BMJ Case Rep

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Section: Images In…mentioning

confidence: 96%

Effectiveness of a pleuroperitoneal shunt for refractory hepatic hydrothorax that appeared after ligation of a communicating hydrocele

Nakatsuji

Yoshizawa²,

Ohyama³

2021

BMJ Case Rep

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“…Endothelin‐1/Nitric oxide ratio aid in predicting response to terlipressin therapy 103 . Urinary values of neutrophil gelatinase‐associated lipocalin (NGAL), interleukin‐18 (IL‐18), kidney injury molecule‐1 (KIM‐1), liver type fatty acid‐binding protein (L‐FABP) and albumin can aid in differentiating AKI caused by ATN from non‐ATN 104,105 . But none of these biomarkers has been assessed to predict response to terlipressin therapy.…”

Section: Future Researchmentioning

confidence: 99%

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Kulkarni

Arab

Premkumar

et al. 2020

Liver International

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Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice‐changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as “terlipressin,” “hepatorenal syndrome,” “varices, esophagal and gastric,” “ascites” and “cirrhosis.” Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute‐on‐chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis‐induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.

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“…By contrast, the absence of response to volume expansion defines the hepatorenal syndrome type of AKI (HRS‐AKI), formerly called ‘type 1 hepatorenal syndrome’. Interestingly, the diagnostic criteria of hepatorenal syndrome have been revised by the ICA in 2015 (Figure 2) and the new name of type 1 hepatorenal syndrome is now HRS‐AKI 20 …”

Section: Clinical Vignettementioning

confidence: 99%

“…The cornerstone of the initial management of HRS‐AKI is fluid resuscitation with albumin in combination with the early administration of vasoactive drugs. By counteracting the splanchnic arterial vasodilation associated with HRS‐AKI, vasoconstrictors improve the renal circulation 20 . In the setting of HRS‐AKI, terlipressin remains the most commonly used vasoconstrictor.…”

Section: Clinical Vignettementioning

confidence: 99%

Global strategy for the diagnosis and management of acute kidney injury in patients with liver cirrhosis

Sanchez

Francoz

2021

UEG Journal

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Acute kidney injury is a clinical syndrome that complicates the course and worsens clinical outcomes in patients with chronic liver diseases. It is a common complication in hospitalised patients with liver cirrhosis, especially those with decompensated cirrhosis, associated with a high mortality rate. Considering its impact on patient prognosis, efforts should be made to diagnose and tailor therapeutic interventions for acute kidney injury at an early stage. In the past decade, significant progress has been made to understand the key events and define major prognostic factors for the onset and progression of acute kidney injury in the cirrhotic population leading hepatologists to re-define the classic definition of hepatorenal syndrome and renal failure in this specific population.

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Hepatorenal syndrome: pathophysiology, diagnosis, and management

Cited by 151 publications

References 152 publications

Effectiveness of a pleuroperitoneal shunt for refractory hepatic hydrothorax that appeared after ligation of a communicating hydrocele

Effectiveness of a pleuroperitoneal shunt for refractory hepatic hydrothorax that appeared after ligation of a communicating hydrocele

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Global strategy for the diagnosis and management of acute kidney injury in patients with liver cirrhosis

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