Studies on the renin-angiotensin-aldosterone system in patients with cirrhosis and ascites: Effect of saline and albumin infusion

Wong, Patrick; Carroll, Robert E.; Lipinski, Thomas L.; Capone, Richard R.

doi:10.1016/0016-5085(79)90153-7

Cited by 31 publications

(6 citation statements)

References 23 publications

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“…Alternatively, this result also indicates that the possible negative impact on renal function is because of a reduced effective blood volume in HCC patients with ascites (32). A previous study reported a favourable effect on renal blood flow and GFR after the administration of albumin in cirrhosis patients (33). In addition, patients receiving albumin infusion after therapeutic paracentesis showed significantly less changes in electrolyte and serum creatinine levels (34).…”

Section: Discussionmentioning

confidence: 92%

Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization

Hsu

Huang

et al. 2010

Liver International

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Section: Discussionmentioning

confidence: 92%

Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization

Hsu

Huang

et al. 2010

Liver International

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“…Logistic regression analysis among HCC patients with ascites found that hypoalbuminemia was the only risk factor independently predictive of post-TACE AKI. Based on earlier reports, the authors speculated whether nephroprotection by albumin might result from increased renal blood flow and GFR[ 52 ], decreased changes in electrolyte and serum creatinine levels[ 52 ], or plasma expansion[ 53 , 54 ].…”

Section: Cancermentioning

confidence: 99%

Causal relationship between hypoalbuminemia and acute kidney injury

Wiedermann¹,

Wiedermann²,

Joannidis³

2017

WJN

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Our meta-analysis published in 2010 provided evidence that low levels of serum albumin (hypoalbuminemia) are a significant independent predictor of acute kidney injury (AKI) and death following AKI. Since then, a large volume of additional data from observational clinical studies has been published further evaluating the relationship between serum albumin and AKI occurrence. This is an updated review of the literature to re-evaluate the hypothesis that hypoalbuminemia is independently associated with increased AKI risk. Eligible studies published from September 2009 to December 2016 were sought in PubMed (MEDLINE) and forty-three were retained, the great majority being retrospective observational cohort studies. These included a total of about 68000 subjects across a diverse range of settings, predominantly cardiac surgery and acute coronary interventions, infectious diseases, transplant surgery, and cancer. Appraisal of this latest data set served to conclusively corroborate and confirm our earlier hypothesis that lower serum albumin is an independent predictor both of AKI and death after AKI, across a range of clinical scenarios. The body of evidence indicates that hypoalbuminemia may causally contribute to development of AKI. Furthermore, administration of human albumin solution has the potential to prevent AKI; a randomized, controlled study provides evidence that correcting hypoalbuminemia may be renal-protective. Therefore, measurement of serum albumin to diagnose hypoalbuminemia may help identify high-risk patients who may benefit from treatment with exogenous human albumin. Multi-center, prospective, randomized, interventional studies are warranted, along with basic research to define the mechanisms through which albumin affords nephroprotection.

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“…In patients with cirrhosis, volume expansion is associated with an acute suppression of the reninangiotensin-aldosterone and sympathetic nervous systems, indicating that the elevation in plasma renin and aldosterone reflects relative hypovolemia [17,18]. However, an effect of plasma expansion on central blood volume is only seen in patients with mild cirrhosis, probably due to the increased vascular compliance associated with moderate and severe cirrhosis [19,20].…”

Section: The Rationale Behind Pharmacological Treatment Of Hepatorenamentioning

confidence: 98%

Vasoconstrictor Therapy for Hepatorenal Syndrome in Liver Cirrhosis

Schmidt¹,

Ring‐Larsen²

2006

CPD

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Hepatorenal syndrome is a severe, but not uncommon complication of decompensated liver cirrhosis. In particular, the rapidly progressive form of hepatorenal syndrome (type 1) is associated with a dismal prognosis. Established hepatorenal syndrome has a spontaneous reversibility below 5%. Hepatorenal syndrome is involved in more than 50% of cirrhosis-related mortality. Thus, any treatment capable of reversing hepatorenal syndrome would be expected to reduce morbidity and mortality from liver cirrhosis. A pathophysiological hallmark of hepatorenal syndrome is arterial underfilling due to an extreme splanchnic vasodilatation. Consequently, potent vasoconstrictors capable of reversing this vasodilatation have been investigated in hepatorenal syndrome. Several vasoconstrictors including the alpha-adrenergic agonists, midodrine and noradrenalin, and the vasopressor analogues, ornipressin and terlipressin, have all been associated with a significant improvement in renal function in 57 to 100% of cases and even reversal of hepatorenal syndrome in 42 to 100% of cases. The majority of recent studies are on terlipressin. A randomized, controlled trial showed a significant effect of terlipressin on reversal of hepatorenal syndrome. The contribution of volume expansion to the beneficial effects of vasoconstrictors on hepatorenal syndrome remains to be determined. In general, reversal of hepatorenal syndrome was associated with an improved survival. However, it remains to be determined if vasoconstrictor therapy should be used in hepatorenal syndrome in general, or if it should be reserved for potential candidates for liver transplantation. In conclusion, evidence for a beneficial effect of vasoconstrictor therapy for the treatment of hepatorenal syndrome is steadily accumulating. Confirmation of the preliminary data in larger randomized, controlled trials looking at long-term survival is required.

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Studies on the renin-angiotensin-aldosterone system in patients with cirrhosis and ascites: Effect of saline and albumin infusion

Cited by 31 publications

References 23 publications

Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization

Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization

Causal relationship between hypoalbuminemia and acute kidney injury

Vasoconstrictor Therapy for Hepatorenal Syndrome in Liver Cirrhosis

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