Transplantation of Cadaveric Kidneys from Patients with Hepatorenal Syndrome

Koppel, M H; Coburn, Jack W.; Mims, Matlock M.; Goldstein, H. H.; Boyle, James D.; Rubini, Milton E.

doi:10.1056/nejm196906192802501

Cited by 271 publications

(27 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, the renal hemo dynamic and sodium reabsorptive changes have been described as functional and potentially reversible [14]. The current results support that impression of reversibility.…”

Section: Discussionsupporting

confidence: 82%

The ‘Hepatorenal’ Syndrome and Refractory Ascites

Mj¹,

Schneider²,

Wapnick³

et al. 1979

Nephron

View full text Add to dashboard Cite

The charts of 30 consecutive patients who underwent implantation of a LeVeen type of peritoneal-venous (P-V) shunt were reviewed. 29 patients had Laennec’s cirrhosis and ascites refractory to medical therapy. Of these, 7 or 24% had hepatorenal syndrome (HRS), i.e. creatininemia and azotemia, a low urinary sodium (UNa), and no other apparent cause for renal failure. In these patients with plasma creatinine (pCr) > 1.6 mg/dl and BUN > 30 mg/dl and UNa < 10 mEq/1, the P-V shunt s ingificantly improved all 3 measures of renal function: pCr decreased from 4.3 to 2.7 mg/dl (p < 0.025) BUN decreased from 79 to 38 mg/dl (p < 0.025) and UNa increased to 70 mEq/1. 4 of these patients are still alive, a mean of 418 days after being shunted (preshunt BUN = 60 mg/dl). 3 patients died a mean of 81.7 days after shunt implantation (preshunt BUN = 83 mg/dl), none from renal failure. Of the 29 patients with refractory ascites, + / – HRS, the implantation of this shunt was associated with a significant increase in renal sodium clearance (CNa) and fraction of the filtered sodium being excreted CNa/Ccr. The CNa/Ccr increased after shunting in patients studied while off diuretics from 0.21 to 1.45% (p < 0.025). The avid renal salt adsorption characteristic of refractory ascites and HRS appears to have been reversed. The P-V shunt appears to be beneficial therapy, especially in preterminal HRS, and appears to function in a physiologic manner, by decreasing the renal reabsorption of sodium and water.

show abstract

Section: Discussionsupporting

confidence: 82%

The ‘Hepatorenal’ Syndrome and Refractory Ascites

Mj¹,

Schneider²,

Wapnick³

et al. 1979

Nephron

View full text Add to dashboard Cite

show abstract

“…10 Hecker and Sherlock in 1956 gave the first detailed description of HRS. 11 Vesin 12 and Koppel et al 13 later established the functional nature of this renal disease. Since then, the relationship between the liver and kidney functions has been an object of great research effort.…”

Section: Discussionmentioning

confidence: 99%

Clinical Spectrum of Renal Disorders in Patients with Cirrhosis of Liver

et al. 2011

View full text Add to dashboard Cite

Background: There are limited studies describing various renal disorders and their prognostic impact in patients with cirrhosis of liver. The aim of this work was to study the clinical spectrum of renal disorders in patients with cirrhosis of liver and their prognostic impact. Methods: Patients with diagnosis of cirrhosis of liver were included in this study. Cirrhosis was diagnosed using standard clinical criteria. The cirrhotic patients were prospectively analyzed for the presence of renal diseases during the study period from January 2008 to April 2009. Results: Four hundred and four patients were included in this study and renal diseases were present in 44% (n = 178) patients. The spectrum of renal diseases were acute kidney injury (AKI; 24.5%), chronic kidney disease (CKD; 15.6%), acute on chronic renal failure (1.5%), nephritic syndrome (1.5%), and nephrotic syndrome (1%). The types of AKI were acute tubular necrosis (ATN; 44.4%), prerenal failure (36.4%), and hepatorenal syndrome (19.2%). The incidence of renal diseases was 15.7% in class A, 50% in class B, and 54.8% in class C cirrhosis. There was significant increase in mortality in patients with class C cirrhosis versus without renal disease (78.1% vs. 53.2%; p < 0.001). Conclusions: Renal diseases were present in a significant proportion (44%) of cirrhotic patients. ATN was the commonest form of AKI and we noted that the prevalence of CKD was 15.6% in our cirrhotic patients. The incidence of renal disease increased with increase in severity of cirrhosis of liver. The presence of renal disease seems to have adverse prognostic impact on class C cirrhosis.

show abstract

“…It is noteworthy to mention that liver transplantation in these patients is often associated with a return of normal renal function [66]. Unfortunately, many patients with hepatorenal syndrome die before a donor liver can be found.…”

Section: Hepatorenal Syndrome and Acetaminophen Poisoningmentioning

confidence: 99%

The Isoprostanes: Unique Prostaglandin-Like Products of Free-Radical-Initiated Lipid Peroxidation*

Morrow

Chen

Brame

et al. 1999

Drug Metabolism Reviews

117

View full text Add to dashboard Cite

The discovery of IsoPs as products of nonenzymatic lipid peroxidation has opened up new areas of investigation regarding the role of free radicals in human physiology and pathophysiology. The quantification of IsoPs as markers of oxidative stress status appears to be an important advance in our ability to explore the role of free radicals in the pathogenesis of human disease. An important need in the field of free-radical medicine is information regarding the clinical pharmacology of antioxidant agents. Because of the evidence implicating free radicals in the pathogenesis of a number of human diseases, large clinical trials are planned or underway to assess whether antioxidants can either prevent the development or ameliorate the pathology of certain human disorders. However, data regarding the most effective doses and combination of antioxidant agents to use in these clinical trials is lacking. As mentioned previously, administration of antioxidants suppresses the formation of IsoPs, even in normal individuals. Thus, measurement of IsoPs may provide a valuable approach to define the clinical pharmacology of antioxidants. In addition to being markers of oxidative stress, several IsoPs possess potent biological activity. The availability of additional IsoPs in synthetic form should broaden our knowledge concerning the role of these molecules as mediators of oxidant stress. Despite the fact that considerable information has been obtained since the initial report of the discovery of IsoPs [6], much remains to be understood about these molecules. With continued research in this area, we believe that much new information will emerge that will open up additional important new areas for future investigation.

show abstract

Transplantation of Cadaveric Kidneys from Patients with Hepatorenal Syndrome

Cited by 271 publications

References 14 publications

The ‘Hepatorenal’ Syndrome and Refractory Ascites

The ‘Hepatorenal’ Syndrome and Refractory Ascites

Clinical Spectrum of Renal Disorders in Patients with Cirrhosis of Liver

The Isoprostanes: Unique Prostaglandin-Like Products of Free-Radical-Initiated Lipid Peroxidation*

Contact Info

Product

Resources

About