Bolaños RH

Language: Spanish
References: 12
Page: 357-361
PDF size: 318.28 Kb.

ABSTRACT

Renal failure is a common complication of patients with advanced cirrhosis. It generally indicates a poor prognosis because of the combined detrimental effect of renal and liver failure. In some cases, renal failure in cirrhosis is due to a etiological factors that also lead to renal failure in patients without liver disease, such as severe dehydration, shock (haemorrhagic or septic), or nephrotoxic drugs, or is the consequence of an intrinsic renal parenchymal disease, such as glomerulonephritis. However, in other cases renal failure in cirrhosis occurs in the absence of these factors and with normal renal histology. This disorder is known as hepatorenal syndrome (HRS). It is caused by intense vasoconstriction of the renal circulation, which leads to a pronounced reduction in glomerular filtration rate (GFR). Although HRS was described more than 50 years ago, many features of its pathogenesis and natural history remained unknown for many years. No effective treatment existed until very recently. The aim of this seminar is to provide an up to date revision of HRS, with special emphasis on its diagnosis and management.

REFERENCES

1. Arroyo V, Ginès P, Gerbes A, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996; 23: 164-176.

2. Brensing KA, Textor J, Perz J, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut 2000; 47: 288-295.

3. Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994; 20; 1495-1501.

4. Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of hepatorenal syndrome in cirrhosis. Gastroenterology 1993; 105: 229-236.

5. Gines, Guevara, Arroyo. Hepatorrenal Syndrome. The Lancet, Volume 362; November 29, 2003.

6. Gonwa TA, Wilkinson AH. Liver transplantation and renal function: Results in patients with and without hepatorenal syndrome. In: Epstein M (ed) The kidney in liver disease, Fourth ed, Phyladelphya; Hanley&Belfus, 1996: 529-542.

7. Guevara M, Ginès P, Fernández-Esparrach G, et al. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology 1998; 27: 35-41.

8. Guevara M, Ginès P, Bandi JC, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome. Effects on renal function and vasoactive systems. Hepatology 1998; 27:35-41.

9. Guevara M, Ginès P, Bandi JC, et al. Transjugular intrahepatic portosystemic shunts un heparorenal syndrome: effects on renal function and vasoactive systems. Hepatology 1998; 2: 416-422.

10. Gülberg V, Bilzer M, Gerbes AL. Long-term therapy and retreatment of hepatorenal syndrome type I with ornipressin and dopamine. Hepatology 1999; 30: 870-875.

11. Moore K: The hepatorenal syndrome. Clin Sci 1997; 92: 433-443.

12. Papper S: Hepatorenal syndrome. En: Epstein M (ed) The kidney in liver disease, First edition, New York: Elsevier Biomedical, 1978: 91-112.