Hepatorenal syndrome. Studies of the effect of vascular volume and intraperitoneal pressure on renal and hepatic function

Cade, Robert; Wagemaker, Herbert; Vogel, Stephen B.; Mars, Donald R.; Hood-Lewis, Dennis; Privette, Malcolm; Peterson, John C.; Schlein, Edward; Hawkins, Richard A.; Raulerson, Daniel; Campbell, Kelly

doi:10.1016/0002-9343(87)90442-6

Cited by 55 publications

(13 citation statements)

References 18 publications

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“…On the other hand, inferior vena cava pressure was in creased in patients with ascites. This last finding was prob ably due to fluid accumulation in the abdominal cavity [10] As a result of increased inferior vena cava pressure, renal perfusion pressure decreased. Since the normal response to decreased renal perfusion pressure is a renal vasodilation [11], the trend for increased renal resistance in our patients with ascites suggests that a renal vasoconstrictor mecha nism hindered renal vasodilation.…”

Section: Discussionmentioning

confidence: 96%

Renal Hemodynamics in Patients with Cirrhosis: Relationship with Ascites and Liver Failure

Moreau

Gaudin

Hadengue

et al. 1993

Nephron

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In patients with cirrhosis and ascites decreased renal blood flow might be related to the severity of liver disease but the relationship beween the severity of cirrhosis and renal perfusion has not yet been established. Thus we measured renal, systemic and splanchnic hemodynamics in 63 patients with ascites and in 28 without ascites. When compared to patients without ascites, patients with ascites had lower renal blood flow (1,170 ± 100 vs. 935 ± 55 ml/min/1.73 m²; mean ± SEM, p < 0.05) and renal perfusion pressure (78 ± 2 vs. 72 ± 1 mm Hg, p < 0.05 and higher inferior vena cava pressure (6.5 ± 0.7 vs. 10.7 ± 0.7 mm Hg, p < 0.05). Patients with ascites had significantly higher serum bilirubin concentrations, hepatic venous pressure gradient and lower serum albumin concentrations, indocyanine green (ICG) extraction than patients without ascites. Renal vascular resistance, glomerular filtration rate, mean arterial pressure, cardiac index and systemic vascular resistance were not significantly different between the two groups. By multiple regression analysis no significant correlation was found between liver tests (i.e., prothrombin time, serum bilirubin and albumin concentrations, ICG extraction), hepatic venous pressure gradient, cardiac index and systemic vascular resistance on the one hand and renal blood flow on the other. No significant correlation was found between glomerular filtration rate and liver tests. In conclusion, in patients with cirrhosis and ascites, renal hypoperfusion is not related to the severity of liver disease.

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Section: Discussionmentioning

confidence: 96%

Renal Hemodynamics in Patients with Cirrhosis: Relationship with Ascites and Liver Failure

Moreau

Gaudin

Hadengue

et al. 1993

Nephron

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“…It has been shown that increased intra-abdominal pressure can cause acute renal failure in humans and animals (15, 16). Removal of this pressure resulted in immediate improvement in renal function and resolution of anuria (16–19). In our study, a mean of 16.53 L of fluid was removed over a period of 72 h. This corresponded with a mean drop of 8.7 kg body weight between day 1 and day 3.…”

Section: Discussionmentioning

confidence: 99%

Large-volume paracentesis with indwelling peritoneal catheter and albumin infusion: a community hospital study

Martín

Walayat

Ahmed

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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BackgroundThe management of ascites can be problematic. This is especially true in patients with diuretic refractory ascites who develop a tense abdomen. This often results in hypotension and decreased venous return with resulting renal failure. In this paper, we further examine the risks and benefits of utilizing an indwelling peritoneal catheter to remove large-volume ascites over a 72-h period while maintaining intravascular volume and preventing renal failure.MethodsWe retrospectively reviewed charts and identified 36 consecutive patients undergoing continuous large-volume paracentesis with an indwelling peritoneal catheter. At the time of drain placement, no patients had signs or laboratory parameters suggestive of spontaneous bacterial peritonitis. The patients underwent ascitic fluid removal through an indwelling peritoneal catheter and were supported with scheduled albumin throughout the duration. The catheter was used to remove up to 3 L every 8 h for a maximum of 72 h. Regular laboratory and ascitic fluid testing was performed. All patients had a clinical follow-up within 3 months after the drain placement.ResultsAn average of 16.5 L was removed over the 72-h time frame of indwelling peritoneal catheter maintenance. The albumin infusion utilized correlated to 12 mg/L removed. The average creatinine trend improved in a statistically significant manner from 1.37 on the day of admission to 1.21 on the day of drain removal. No patients developed renal failure during the hospital course. There were no documented episodes of neutrocytic ascites or bacterial peritonitis throughout the study review.ConclusionLarge-volume peritoneal drainage with an indwelling peritoneal catheter is safe and effective for patients with tense ascites. Concomitant albumin infusion allows for maintenance of renal function, and no increase in infectious complications was noted.

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“…Oliguria or even anuria develops despite measured normal or mildly elevated CPV and PAWP due to IAH-induced reductions in renal blood flow and function [26,27]. Because of IAP renal vein and renal vascular resistance are both significant elevated leading to impaired glomerular and tubular renal function and reduction in urinary output [23,26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Because of IAP renal vein and renal vascular resistance are both significant elevated leading to impaired glomerular and tubular renal function and reduction in urinary output [23,26,27]. Nevertheless interesting is the fact that renal failure in the absence of pulmonary dysfunction is not likely to be the result of IAH [22].…”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal hypertension due to heparin - induced retroperitoneal hematoma in patients with ventricle assist devices: report of four cases and review of the literature

Daliakopoulos

Schaedel

Klimatsidas

et al. 2010

J Cardiothorac Surg

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IntroductionElevated intra-abdominal pressure (IAP) has been identified as a cascade of pathophysiologic changes leading in end-organ failure due to decreasing compliance of the abdomen and the development of abdomen compartment syndrome (ACS). Spontaneous retroperitoneal hematoma (SRH) is a rare clinical entity seen almost exclusively in association with anticoagulation states, coagulopathies and hemodialysis; that may cause ACS among patients in the intensive care unit (ICU) and if treated inappropriately represents a high mortality rate.Case PresentationWe report four patients (a 36-year-old Caucasian female, a 59-year-old White-Asian male, a 64-year-old Caucasian female and a 61-year-old Caucasian female) that developed an intra-abdominal hypertension due to heparin-induced retroperitoneal hematomas after implantation of ventricular assist devices because of heart failure. Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. A 36-year old female (the forth patient) presented with sudden, severe shortness of breath at rest, 10 days after an "acute bronchitis". At the time of the event in all cases international normalized ratio (INR) was <3.5 and partial thromboplastin time <65 sec. The patients were treated surgically, the large hematomas were evacuated and the systemic manifestations of the syndrome were reversed.ConclusionIdentifying patients in the ICU at risk for developing ACS with constant surveillance can lead to prevention. ACS is the natural progression of pressure-induced end-organ changes and develops if IAP is not recognized and treated in a timely manner. Failure to recognize and appropriately treat ACS is fatal while timely intervention - if indicated - is associated with improvements in organ function and patient survival. Means for surgical decision making are based on clinical indicators of adverse physiology, rather than on a single measured parameter.

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Hepatorenal syndrome. Studies of the effect of vascular volume and intraperitoneal pressure on renal and hepatic function

Cited by 55 publications

References 18 publications

Renal Hemodynamics in Patients with Cirrhosis: Relationship with Ascites and Liver Failure

Renal Hemodynamics in Patients with Cirrhosis: Relationship with Ascites and Liver Failure

Large-volume paracentesis with indwelling peritoneal catheter and albumin infusion: a community hospital study

Intra-abdominal hypertension due to heparin - induced retroperitoneal hematoma in patients with ventricle assist devices: report of four cases and review of the literature

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