What’s new in hepatorenal syndrome? An updated review for the nephrologist

Detalhes bibliográficos
Autor(a) principal: Magrico,Rita
Data de Publicação: 2013
Outros Autores: Mateus,Ana, Ramos,Aura
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000400005
Resumo: In advanced cirrhosis, increased levels of vasodilators and impaired cardiac compensatory response decrease effective arterial blood volume, causing vasoconstriction of renal arteries and kidney failure in up to 40% of patients after 5 years of follow-up. Hepatorenal syndrome (HRS) diagnostic criteria are: cirrhosis with ascites; serum creatinine (SCr) &gt; 1.5 mg/dL (with no improvement 2 days after diuretic withdrawal and albumin administration). Shock, nephrotoxics and acute parenchymal kidney disease must be excluded. The HRS is classified in: type 1, defined by a 100% increase in SCr to &gt; 2.5 mg/dL in < 2 weeks, and type 2, with a slower and milder decrease in kidney function. Type 3 HRS is an emerging concept, referring to HRS in patients with coexistent kidney disease. Left untreated, average survival of type 1 HRS is 2 weeks whereas in type 2 it is 6 months. Treatment of HRS lies on reversal of the hepatic disease or liver transplantation (combined liver-kidney transplant may be appropriate for patients who have been on renal replacement therapy (RRT) for more than 8 weeks). However, with today’s available therapy, there may be reversibility of HRS without liver transplant. Type 1 HRS is treated with vasoconstrictors (mainly terlipressin; noradrenalin may be an alternative in patients in intensive care units) and albumin. Reversal of HRS occurs in about half of patients. If SCr does not decrease and patients have classic indications for dialysis, RRT can be used as a second-line treatment until liver recovery or transplant. MARS (molecular readsorbent recirculating systems) and Prometheus systems should be considered experimental. Type 2 HRS treatment is based on repeated large-volume paracentesis and albumin administration. If ineffective, vasconstrictors are used. Since renal impairment is mild, RRT is not indicated. If liver recovery/transplant are unfeasible, patient’s treatment should avoid futilities.
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spelling What’s new in hepatorenal syndrome? An updated review for the nephrologistDialysishepatorenal syndromekidney failureliver cirrhosisterlipressinIn advanced cirrhosis, increased levels of vasodilators and impaired cardiac compensatory response decrease effective arterial blood volume, causing vasoconstriction of renal arteries and kidney failure in up to 40% of patients after 5 years of follow-up. Hepatorenal syndrome (HRS) diagnostic criteria are: cirrhosis with ascites; serum creatinine (SCr) &gt; 1.5 mg/dL (with no improvement 2 days after diuretic withdrawal and albumin administration). Shock, nephrotoxics and acute parenchymal kidney disease must be excluded. The HRS is classified in: type 1, defined by a 100% increase in SCr to &gt; 2.5 mg/dL in < 2 weeks, and type 2, with a slower and milder decrease in kidney function. Type 3 HRS is an emerging concept, referring to HRS in patients with coexistent kidney disease. Left untreated, average survival of type 1 HRS is 2 weeks whereas in type 2 it is 6 months. Treatment of HRS lies on reversal of the hepatic disease or liver transplantation (combined liver-kidney transplant may be appropriate for patients who have been on renal replacement therapy (RRT) for more than 8 weeks). However, with today’s available therapy, there may be reversibility of HRS without liver transplant. Type 1 HRS is treated with vasoconstrictors (mainly terlipressin; noradrenalin may be an alternative in patients in intensive care units) and albumin. Reversal of HRS occurs in about half of patients. If SCr does not decrease and patients have classic indications for dialysis, RRT can be used as a second-line treatment until liver recovery or transplant. MARS (molecular readsorbent recirculating systems) and Prometheus systems should be considered experimental. Type 2 HRS treatment is based on repeated large-volume paracentesis and albumin administration. If ineffective, vasconstrictors are used. Since renal impairment is mild, RRT is not indicated. If liver recovery/transplant are unfeasible, patient’s treatment should avoid futilities.Sociedade Portuguesa de Nefrologia2013-12-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000400005Portuguese Journal of Nephrology &amp; Hypertension v.27 n.4 2013reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000400005Magrico,RitaMateus,AnaRamos,Aurainfo:eu-repo/semantics/openAccess2024-02-06T17:04:43Zoai:scielo:S0872-01692013000400005Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:51.269840Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv What’s new in hepatorenal syndrome? An updated review for the nephrologist
title What’s new in hepatorenal syndrome? An updated review for the nephrologist
spellingShingle What’s new in hepatorenal syndrome? An updated review for the nephrologist
Magrico,Rita
Dialysis
hepatorenal syndrome
kidney failure
liver cirrhosis
terlipressin
title_short What’s new in hepatorenal syndrome? An updated review for the nephrologist
title_full What’s new in hepatorenal syndrome? An updated review for the nephrologist
title_fullStr What’s new in hepatorenal syndrome? An updated review for the nephrologist
title_full_unstemmed What’s new in hepatorenal syndrome? An updated review for the nephrologist
title_sort What’s new in hepatorenal syndrome? An updated review for the nephrologist
author Magrico,Rita
author_facet Magrico,Rita
Mateus,Ana
Ramos,Aura
author_role author
author2 Mateus,Ana
Ramos,Aura
author2_role author
author
dc.contributor.author.fl_str_mv Magrico,Rita
Mateus,Ana
Ramos,Aura
dc.subject.por.fl_str_mv Dialysis
hepatorenal syndrome
kidney failure
liver cirrhosis
terlipressin
topic Dialysis
hepatorenal syndrome
kidney failure
liver cirrhosis
terlipressin
description In advanced cirrhosis, increased levels of vasodilators and impaired cardiac compensatory response decrease effective arterial blood volume, causing vasoconstriction of renal arteries and kidney failure in up to 40% of patients after 5 years of follow-up. Hepatorenal syndrome (HRS) diagnostic criteria are: cirrhosis with ascites; serum creatinine (SCr) &gt; 1.5 mg/dL (with no improvement 2 days after diuretic withdrawal and albumin administration). Shock, nephrotoxics and acute parenchymal kidney disease must be excluded. The HRS is classified in: type 1, defined by a 100% increase in SCr to &gt; 2.5 mg/dL in < 2 weeks, and type 2, with a slower and milder decrease in kidney function. Type 3 HRS is an emerging concept, referring to HRS in patients with coexistent kidney disease. Left untreated, average survival of type 1 HRS is 2 weeks whereas in type 2 it is 6 months. Treatment of HRS lies on reversal of the hepatic disease or liver transplantation (combined liver-kidney transplant may be appropriate for patients who have been on renal replacement therapy (RRT) for more than 8 weeks). However, with today’s available therapy, there may be reversibility of HRS without liver transplant. Type 1 HRS is treated with vasoconstrictors (mainly terlipressin; noradrenalin may be an alternative in patients in intensive care units) and albumin. Reversal of HRS occurs in about half of patients. If SCr does not decrease and patients have classic indications for dialysis, RRT can be used as a second-line treatment until liver recovery or transplant. MARS (molecular readsorbent recirculating systems) and Prometheus systems should be considered experimental. Type 2 HRS treatment is based on repeated large-volume paracentesis and albumin administration. If ineffective, vasconstrictors are used. Since renal impairment is mild, RRT is not indicated. If liver recovery/transplant are unfeasible, patient’s treatment should avoid futilities.
publishDate 2013
dc.date.none.fl_str_mv 2013-12-01
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dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
dc.source.none.fl_str_mv Portuguese Journal of Nephrology &amp; Hypertension v.27 n.4 2013
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instacron_str RCAAP
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collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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