Response to Dopamine Hydrochloride in the Hepatorenal Syndrome

Bennett, William M.; Keeffe, Emmet B.; Melnyk, Clifford S.; Mahler, Delmar J.; Rösch, Josef; Porter, George A.

doi:10.1001/archinte.1975.00330070086014

Cited by 65 publications

(9 citation statements)

References 20 publications

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“…Thus, the redistribution of blood from nonessential vascular beds to the kidney mediated by vasoconstricting substances might be of benefit for the kidney even in the case of a hepatorenal syndrome. Such a therapeutic regime, already proposed previously (22), is in agreement with the suggestion of Fischer and Bower (23) that a successful therapy of hepatorenal syndrome would demand an alteration of the overall cardiovascular haemodynamics. However, further clinical experience will be necessary in order to prove the beneficial effect of such a therapeutic regime, especially during long-term use of vasoconstrictors.…”

Section: Discussionsupporting

confidence: 89%

Function of the Autonomic Nervous System in Patients With Hepatic Encephalopathy

Lenz¹,

Hörtnagl²,

Magometschnigg³

et al. 1985

Hepatology

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To obtain further pathophysiological details concerning the development of cardiovascular disturbances in severe liver disease, the state of the autonomic nervous system, the function of the baroreceptor reflex pathway and the responsiveness of the cardiovascular system to noradrenaline, angiotensin II and isoprenaline were investigated in 11 patients with hepatic encephalopathy and in 10 healthy control subjects. Increased plasma levels of noradrenaline and adrenaline and an attenuated increase in heart rate in response to atropine were found in patients with hepatic encephalopathy. These changes and the hemodynamic disturbances tended to be more pronounced in patients with hepatic encephalopathy Grades III-IV as compared to hepatic encephalopathy Grades I-II. The increase in systolic blood pressure induced by infusion of noradrenaline (400 ng per kg per min) and angiotensin II (20 ng per kg per min) was higher in the patients than in healthy control subjects (hepatic encephalopathy Grades I-II: p less than 0.001; hepatic encephalopathy Grades III-IV: p less than 0.02). The changes in mean and diastolic blood pressure in response to angiotensin II were more pronounced in hepatic encephalopathy grades I-II than in hepatic encephalopathy Grades III-IV (p less than 0.02). The decrease of heart rate in response to blood pressure increase in patients with hepatic encephalopathy was not different from control subjects except a smaller decrease during angiotensin II infusion in hepatic encephalopathy grades III-IV (p less than 0.05). The responsiveness to isoprenaline was diminished (p less than 0.001). The present results indicate that the increased activity of the sympathetic nervous system in hepatic encephalopathy is associated with decreased parasympathetic tone.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 89%

Function of the Autonomic Nervous System in Patients With Hepatic Encephalopathy

Lenz¹,

Hörtnagl²,

Magometschnigg³

et al. 1985

Hepatology

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“…This contrasts with the increase in GFR observed at the same doses in noncirrhotic patients ( 1,23). Our results, however, are similar to previous studies showing that low doses of dopamine failed to increase GFR in patients with cirrhosis (24,25,29). Another study has also shown that dopamine induced a decrease in GFR in patients with cirrhosis (30).…”

Section: Discussionsupporting

confidence: 92%

Systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine in patients with cirrhosis

et al. 1991

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The effects of dopamine on kidney function have not been elucidated in patients with cirrhosis. Moreover, although increased portal pressure has been observed with supradopaminergic doses of dopamine in these patients, the splanchnic hemodynamic effects of low doses of dopamine have not been previously studied. Thus we studied the acute systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine (1.5 micrograms/kg body wt min) in nine cirrhotic patients. Plasma dopamine levels increased markedly from 35 +/- 20 pg/ml to 31,400 +/- 4,900 pg/ml during dopamine administration. A significant diastolic pressure decrease of 10% was associated with a 15% increase in heart rate. Cardiac output was not altered. Although dopamine significantly increased azygos blood flow by 16%, wedged and free hepatic venous pressures were not altered. Dopamine significantly increased renal blood flow by 31%, but did not change the glomerular filtration rate. We conclude that a dopaminergic dose of dopamine increases azygos blood flow but not the hepatic venous pressure gradient. Finally, although it increases renal blood flow, dopamine does not seem to have any beneficial effects on glomerular filtration rate in cirrhotic patients.

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“…However, there was no obvious benefit. [16][17][18][19][20] The combination of peripheral vasoconstrictors and renal vasodilators has also failed to improve renal function in cases of HRS. 21 There are many reports of small numbers of cases treated with other vasoactive substances that produced positive results.…”

Section: Medical Treatment Of Hepatorenal Sydromementioning

confidence: 99%

Management of refractory ascites and hepatorenal syndrome

Chutaputti¹

2002

J of Gastro and Hepatol

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Refractory ascites and hepatorenal syndrome (HRS) are the late complications of the terminal stages of cirrhosis. The definitions of refractory ascites and HRS proposed by the International Ascites Club in 1996 are now widely accepted, and are useful in diagnosis, treatment and research in this field. In both conditions, the only treatment of proven value for improved survival is liver transplantation. However, because of better understanding about the pathophysiology of HRS, including the roles of portal hypertension, ascites formation and hemodynamic derangements, treatments such as transjugular intrahepatic portasystemic shunt (TIPS) and new pharmacological agents may be considered to alleviate the problem prior to transplantation. Symptomatic treatment of refractory ascites includes TIPS and repeated large volume paracentesis. Transjugular intrahepatic portasystemic shunt can improve survival while waiting for liver transplantation. Practical management guidelines for TIPS and large volume paracentesis, including the prevention and management of further complications, are considered in this review.

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Response to Dopamine Hydrochloride in the Hepatorenal Syndrome

Cited by 65 publications

References 20 publications

Function of the Autonomic Nervous System in Patients With Hepatic Encephalopathy

Function of the Autonomic Nervous System in Patients With Hepatic Encephalopathy

Systemic, splanchnic and renal hemodynamic effects of a dopaminergic dose of dopamine in patients with cirrhosis

Management of refractory ascites and hepatorenal syndrome

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