Renal failure after upper gastrointestinal bleeding in cirrhosis. Incidence, clinical course, predictive factors and short-term prognosis

Cárdenas, Andrés; Ginès, Pere; Úriz, J.; Bessa, X.; Salmerón, JM; Mas, Antoni; Ortega, Rolando; Calahorra, B.; Heras, D. De Las; Bosch, Jaime; Arroyo, Vicente; Rodés, Juan

doi:10.1016/s0168-8278(01)81104-1

Cited by 83 publications

(123 citation statements)

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“…Similarly, large-volume paracentesis without albumin expansion precipitates type 1 HRS in 15% of cases, and 25% of patients who present with acute alcoholic hepatitis eventually develop HRS (74,75). Although ARF after gastrointestinal hemorrhage occurs more frequently in patients with cirrhosis compared with those without liver disease with similar amount of bleeding (8 versus 1%; P Ͻ 0.05), ARF develops almost exclusively in patients with hypovolemic shock, making acute tubular necrosis (ATN) a more plausible diagnosis (76). Intravascular volume depletion by overzealous diuretic use has been considered a triggering factor for HRS; however, evidence to support this is lacking (77).…”

Section: Precipitating Factorsmentioning

confidence: 99%

Hepatorenal Syndrome

Wadei

Martin

Ahsan

et al. 2006

Clinical Journal of the American Society of Nephrology

229

194

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Section: Precipitating Factorsmentioning

confidence: 99%

Hepatorenal Syndrome

Wadei

Martin

Ahsan

et al. 2006

Clinical Journal of the American Society of Nephrology

229

194

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“…The prevalence of AKI in cirrhotic patients with variceal bleeding is reported to be 11% (52). The use of vasoactive agents such as terlipressin together with appropriate volume repletion, endoscopic treatment of bleeding varices and the use of prophylactic antibiotic therapy significantly decrease renal dysfunction and mortality rates in these patients (53).…”

Section: Variceal Bleedingmentioning

confidence: 99%

Renal dysfunctions in cirrhosis

2016

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Kidney dysfunction is a common and potentially life-threating event in patients with cirrhosis, and underlying mechanisms for renal dysfunction are quite variable. Acute kidney injury (AKI) is relatively frequent encountered in approximately 20% of hospitalized patients with cirrhosis. Nevertheless, chronic kidney disease (CKD) occurs in almost 1% of all patients with cirrhosis. In this review various renal problems encountered in cirrhotic patients are discussed and strategies to prevent renal dysfunction are suggested.

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“…5 In 50-70% of patients, HRS is preceded by an event that may be a precipitating factor. 5,7 Several precipitating factors have been identified: severe bacterial infections (without shock) such as spontaneous bacterial peritonitis (SBP) or septicemia; 5,7 portal hypertensive bleeding (without shock); 5,7,19 therapeutic paracentesis (even if ascites removal is followed by the administration of a plasma expander); 7 and acute alcoholic hepatitis. 20 Certain patients may have more than one precipitating factor.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Interestingly, another study performed in cirrhotic patients admitted for upper gastrointestinal bleeding showed that the only variables with predictive value for in-hospital mortality were the presence of hemorrhagic shock and the development of renal failure. 19 Most patients die from multiorgan failure: liver failure, renal failure (terminal ischemic tubular necrosis), circulatory failure and acute respiratory distress syndrome. 5 Multiorgan failure is precipitated by severe bacterial infections that are known to occur during the course of HRS.…”

Section: Prognosis Of Hepatorenal Syndromementioning

confidence: 99%

“…56 Bacterial infections or portal hypertensive bleeding are precipitating factors of HRS. 5,7,19 Thus, prevention of precipitating factors may be useful in preventing HRS. In a recent consensus conference, the use of norfloxacin in patients admitted for gastrointestinal bleeding and in patients who recovered from an episode of SBP was recommended to prevent bacterial infections.…”

Section: Prevention Of Hepatorenal Syndromementioning

confidence: 99%

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Hepatorenal syndrome in patients with cirrhosis

Moreau

2002

J of Gastro and Hepatol

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Type 1 hepatorenal syndrome (HRS) is a severe complication of end-stage cirrhosis. Type 1 HRS is an acute functional renal failure (i.e. glomerular hypofiltration) with no other explanation than the presence of the circulatory and neurohumoral alterations associated with severe chronic liver disease. Plasma volume expansion does not improve renal function. In contrast, administration of the vasopressin analog terlipressin, a splanchnic and systemic vasoconstrictor, may improve renal function and be used while awaiting liver transplantation. © 2002 Blackwell Publishing Asia Pty LtdKey words : cirrhosis, renal failure, vasoconstrictors. DEFINITIONS AND DIAGNOSISHepatorenal syndrome (HRS) is a renal failure which complicates end-stage cirrhosis with ascites. [1][2][3][4][5] There are two clinical types of HRS: type 1 and 2. 2 Type 1 HRS is characterized by the development of acute renal failure; that is, a doubling of initial serum creatinine to levels above 130 µ mol/L or a 50% decrease in the initial 24-h creatinine clearance to below 20 mL/min in less than 2 weeks. 2 Patients with type 1 HRS are in poor condition. Type 2 HRS is characterized by moderate and stable renal failure in patients who have a better condition than those with type 1 HRS. 2 This review will focus on the mechanisms, diagnosis, prognosis and treatment of type 1 HRS, and the term HRS will be used instead of type 1 HRS.Information on the frequency of HRS is controversial. In a large North American study of 3860 patients with ascites, HRS was diagnosed in less than 1% of patients. 6 Another study of 234 non-azotemic patients with ascites showed that the probability of developing HRS was 20% and 40% at 1 and 5 years, respectively. 7

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Renal failure after upper gastrointestinal bleeding in cirrhosis. Incidence, clinical course, predictive factors and short-term prognosis

Cited by 83 publications

References 0 publications

Hepatorenal Syndrome

Hepatorenal Syndrome

Renal dysfunctions in cirrhosis

Hepatorenal syndrome in patients with cirrhosis

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