Skip to main content

Diagnosis and Management of the Hepatorenal Syndrome

  • Chapter
Portal Hypertension

Part of the book series: Clinical Gastroenterology ((CG))

  • 1265 Accesses

Abstract

The hepatorenal syndrome (HRS) is defined as the development of renal failure in patients with severe liver disease in the absence of any other identifiable cause of renal pathology. Although classically associated with cirrhosis, it is now recognized that a similar syndrome occurs in patients with acute liver failure (1). It is diagnosed following the exclusion of other causes of renal failure in patients with severe liver disease such as hypovolemia, drug nephrotoxicity, sepsis, or glomerulonephritis. The causes of renal failure in/and liver disease are listed in Table 1.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

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

    Article  PubMed  CAS  Google Scholar 

  2. Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105:229–236.

    PubMed  CAS  Google Scholar 

  3. Folio A, Llovet JM, Navasa M, et al. Renal impairment after sponatneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients with cefotaxime. Hepatology 1993:251–257.

    Google Scholar 

  4. Guevara PM, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet 2003;362:1819–1827.

    Article  PubMed  CAS  Google Scholar 

  5. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988;8:1151–1157.

    Article  PubMed  CAS  Google Scholar 

  6. Koppel MH, Coburn JM, Minis MM, et al. Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functional nature of renal failure in advanced liver disease. N Engl J Med 1969;280:1367–1371.

    Article  PubMed  CAS  Google Scholar 

  7. Dudley FJ, Kanel GC, Wood LJ, Reynolds TB. Hepatorenal syndrome without avid sodium retention. Hepatology 1986;6:248–251.

    Article  PubMed  CAS  Google Scholar 

  8. Mandal AK, Lansing M, Fahmy A. Acute tubular necrosis in hepatorenal syndrome: an electron microscopy study. Am J Kidney Dis 1982;2:363–374.

    PubMed  CAS  Google Scholar 

  9. Moore K. The hepatorenal syndrome, din Sci 1997;92:433–443.

    CAS  Google Scholar 

  10. Ma Z, Lee SS. Cirrhotic cardiomyopathy: getting to the heart of the matter. Hepatology 1996;24:451–459.

    Article  PubMed  CAS  Google Scholar 

  11. Ruiz-del-Arbol L, Urman J, Fernandez J, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 2003;38:1210–1218.

    Article  PubMed  Google Scholar 

  12. Fernanadez-Seara J, Prieto J, Quiroga J, et al. Systemic and regional haemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology 1989;97:1304–1312.

    Google Scholar 

  13. Llach J, Gines J, Arroyo V, et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology 1988;94:482–487.

    PubMed  CAS  Google Scholar 

  14. Navar LG. Renal autoregulation: perspectives from whole kidney and single nephron studies. [Review]. Am J Physiol 1978;234:357–370.

    Google Scholar 

  15. Person PB, Ehmeke H, Naf B, Kircheeim HR. Sympathetic modulation of renal autoregulation by carotid occlusion in conscious dogs. Am J Physiol 1990;258:F364–F370.

    Google Scholar 

  16. Kew MC, Varma RR, Sampson DJ, Sherlock S. The effect of octapressin on renal and intrarenal blood flow in cirrhosis of the liver. Gut 1972;13:293–296.

    Article  PubMed  CAS  Google Scholar 

  17. Evrard P, Ruedin P, Installe E, Suter PM. Low-dose ornipressin improves renal function in the hepatorenal syndrome. Critical Care Med 1994;22:363–366.

    Article  CAS  Google Scholar 

  18. Ganne-Carri N, Hadengue A, Mathurin P, et al. Hepatorenal syndrome: long-term treatment with terlipressin as a bridge to liver transplantation. Digest Dis Sci 1996;41:1054–1056.

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  20. Dagher L, Patch D, Marley R, Moore K, Burroughs AK. Pharmacological treatment of the hepatorenal syndrome in cirrhotic patients. Alimentary Pharmacology & Therapeutics 2000;14:515–521.

    Article  CAS  Google Scholar 

  21. Angeli P, Volpin R, Piovan D, et al. Acute effects of the oral administration of midodrine, an alpha-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites. Hepatology 1998;28:937–943.

    Article  PubMed  CAS  Google Scholar 

  22. Lenz K, Hortnagl H, Druml W, et al. Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis. Gastroenterology 1991;101:1060–1067.

    PubMed  CAS  Google Scholar 

  23. Uriz J, Cardenas A, Sort P, et al. Telipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol 2000;33:43–48.

    Article  PubMed  CAS  Google Scholar 

  24. Maroto A, Gines P, Arroyo V, et al. Brachial and femoral artery blood flow in cirrhosis: relationship to kidney dysfunction. Hepatology 1993;17:788–793.

    PubMed  CAS  Google Scholar 

  25. Sato S, Ohnishi K, Sugita S, Okuda K. Splenic artery and superior mesenteric artery blood flow: nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease. Radiology 1987;164:347–352.

    PubMed  CAS  Google Scholar 

  26. Bendtsen F, Schifter S, Henriksen JH. Increased circulating calcitonin gene-related peptide (CGRP) in cirrhosis. J Hepatol 1991;12:118–123.

    Article  PubMed  CAS  Google Scholar 

  27. Vallance P, Moncada S. Hyperdynamic circulation in cirrhosis: a role for nitric oxide? Lancet 1991;337:776–778.

    Article  PubMed  CAS  Google Scholar 

  28. Hecker M, Mülsch A, Bassenge E, Busse R. Vasoconstriction and increased flow: two principle mechhanisms of shear stress-dependent endothelial autacoid release. Am J Physiol 1993;265:H828–H833.

    PubMed  CAS  Google Scholar 

  29. Stark ME, Szurszewski JH. Role of nitric oxide in gastrointestinal and hepatic function and disease. Gastroenterology 1992;103:1928–1949.

    PubMed  CAS  Google Scholar 

  30. Bomzon A, Blendis LM. The nitric oxide hypothesis and the hyperdynamic circulation in cirrhosis. Hepatology 1994;20:1343–1350.

    PubMed  CAS  Google Scholar 

  31. Groszmann RJ. Hyperdynamic circulation of liver disease 40 years later: pathophysiology and clinical consequences. Hepatology 1994;20:1359–1363.

    PubMed  CAS  Google Scholar 

  32. Pierre-Yves M, Gines P, Schrier R. Nitric Oxide as a mediator of haemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med 1998;339:533–541.

    Article  Google Scholar 

  33. Guarner C, Soriano G, Tomas A, et al. Increased serum nitrite and nitrate levels in patients with cirrhosis: relationship to endotoxemia. Hepatology 1993;18:1139–1143.

    PubMed  CAS  Google Scholar 

  34. Claria J, Jimenez W, Ros J, et al. Increased nitric oxide-dependent vasorelaxation in aortic rings of cirrhotic rats with ascites. Hepatology 1994;20:1615–1621.

    Article  PubMed  CAS  Google Scholar 

  35. Mathie RT, Ralevic V, Moore KP, Burnstock G. Mesenteric vasodilator responses in cirrhotic rats: a role for nitric oxide? Hepatology 1996;23:130–136.

    Article  PubMed  CAS  Google Scholar 

  36. Pizcueta MP, Pique JM, Fernandez M, et al. Modulation of the hyperdynamic circulation of cirrhotic rats by nitric oxide inhibition. Gastroenterology 1992;103:1909–1915.

    PubMed  CAS  Google Scholar 

  37. Forrest EH, Jones AL, Dillon JF, Walker J, Hayes PC. The effect of nitric oxide synthase inhibition on portal pressure and azygous blood flow in patients with cirrhosis. J Hepatol 1995;23:254–258.

    Article  PubMed  CAS  Google Scholar 

  38. Atucha NM, Shah V, Garcia-Cardena G, Sessa WE, Groszmann RJ. Role of endothelium in the abnormal response of mesenteric vessels in rats with portal hypertension and liver cirrhosis. Gastroenterology 1996;111:1627–1632.

    Article  PubMed  CAS  Google Scholar 

  39. Ottesen LH, Harry D, Frost M, et al. Increased formation of S-nitrothiols and nitrotyrosine in cirrhotic rats during endotoxemia. Free Radic Biol Med 2001;31:790–798.

    Article  PubMed  CAS  Google Scholar 

  40. Marley R, Feelisch M, Holt S, Moore K. A chemiluminescense-based assay for S-nitrosoalbumin and other plasma S-nitrosothiols. Free Radio Res 2000;32:1–9.

    Article  CAS  Google Scholar 

  41. Guarner F, Guarner C, Prieto J, et al. Increased synthesis of systemic prostacyclin in cirrhotic patients. Gastroenterology 1996;90:687–694.

    Google Scholar 

  42. Moore K, Ward P, Taylor G, Williams R. Systemic and renal production of thromboxane A2 and prostacyclin in decompensated liver disease and hepatorenal syndrome. Gastroenterology 1991;100:1069–1077.

    PubMed  CAS  Google Scholar 

  43. Bruix J, Bosch J, Kravetz D, Mastai R, Rodes J. Effects of prostaglandin inhibition on systemic and hepatic hemodynamics in patients with cirrhosis of the liver. Gastroenterology 1985;88:430–435.

    PubMed  CAS  Google Scholar 

  44. Moreau R, Komeichi H, Kirstetter P, Ohsuga M, Cailmail S, Lebrec D. Altered control of vascular tone by adenosine triphosphate sensitive potassium channels in rats with cirrhosis. Gastroenterology 1994;106:1016–1023.

    PubMed  CAS  Google Scholar 

  45. Moreau R, Komeichi H, Cailmail S, Lebrec D. Blockade of ATP-sensitive K+ channels by glibenclamide reduces portal pressure and hyperkinetic circulation in portal hypertensive rats. J Hepatol 1992;16:215–218.

    Article  PubMed  CAS  Google Scholar 

  46. Moreau R, Lebrec D. Endogenous factors involved in the control of arterial tone in cirrhosis. J Hepatol 1995;22:370–376.

    Article  PubMed  CAS  Google Scholar 

  47. Wilkinson SP, Moodie H, Stamatakis JD, Kakkar VV, Williams R. Endotoxaemia and renal failure in cirrhosis and obstructive jaundice. Br Med J 1976;2:141–158.

    Google Scholar 

  48. Bourgoignie JJ, Valle GA. Endotoxin and renal dysfunction in liver disease. In: Epstein M, ed. The Kidney in Liver Diseases. Williams and Wilkins, Baltimore, MD, 1988, pp. 486–507.

    Google Scholar 

  49. Lumsden AB, Henderson JM, Kutner MIL Endotoxin levels measured by a chromogenic assay in portal hepatic and peripheral venous blood in patients with cirrhosis. Hepatology 1988;8:232–236.

    Article  PubMed  CAS  Google Scholar 

  50. Sheron N, Bird G, Koskinas J, et al. Circulating and tissue levels of the neutrophil chemotaxin interleukin 8 are elevated in severe acute alcoholic hepatitis, and tissue levels correlate with neutrophil infiltration. Hepatology 1993;18:41–46.

    PubMed  CAS  Google Scholar 

  51. Sheron N, Bird G, Goka J, Alexander G, Williams R. Elevated plasma interleukin6 and increased severity and mortality in alcoholic hepatitis. Clin Experi Immunol 1991;84:449–453.

    CAS  Google Scholar 

  52. LopezTalavera JC, Merrill WW, Groszmann RJ. Tumor necrosis factor alpha: a major contributor to the hyperdynamic circulation in prehepatic portalhypertensive rats. Gastroenterology 1995;108:761–767.

    Article  CAS  Google Scholar 

  53. Fernando B, Marley R, Holt S, et al. Acetylcysteine prevents development of the hyperdynamic circulation in the portal hypertensive rat. Hepatology 1998;28:689–694.

    Article  PubMed  CAS  Google Scholar 

  54. Lopez-Talavera JC, Levitzki A, Martinez M, Gazit A, Esteban R, Guardia E. Tyrosine kinase inhibition ameliorates the hyperdynamic state and decreases nitric oxide production in cirrhotic rats with portal hypertension and ascites. J Clin Invest 1997;100:664–670.

    PubMed  CAS  Google Scholar 

  55. Batkai S, Jarai Z, Wagner JA, et al. Endocannabinoids acting at vascular CB1 receptors mediate the vasodilated state in advanced liver cirrhosis. Nat Med 2001;7:827–832.

    Article  PubMed  CAS  Google Scholar 

  56. Ros J, Claria J, To-Figueras J, et al. Endogenous cannabinoids: a new system involved in the homeostasis of arterial pressure in experimental cirrhosis in the rat. Gastroenterology 2002;122:85–93.

    Article  PubMed  CAS  Google Scholar 

  57. Orliac ML, Peroni R, Celuch SM, Adler-Graschinsky E. Potentiation of anandamide effects in mesenteric beds isolated from endotoxemic rats. J Pharmacol Exp Ther 2003;304:179–184.

    Article  PubMed  CAS  Google Scholar 

  58. Varga K, Lake KD, Huangfu D, Guyenet PG, Kunos G. Mechanism of the hypotensive action of anandamide in anesthetized rats. Hypertension 1996;28(4):682–686.

    PubMed  CAS  Google Scholar 

  59. Wilkinson SP, Williams R. Renin-angiotensin-aldosterone system in cirrhosis. Gut 1980;21:545–554.

    Article  PubMed  CAS  Google Scholar 

  60. Schroeder ET, Eich RH, Smulyan H, et al. Plasma renin level in hepatic cirrhosis: relation to functional renal failure. Am J Med 1970;49:189–191.

    Article  Google Scholar 

  61. Laragh JH, Cannon PJ, Bentzel CJ, Sicinski AM, Meltzer J. Angiotensin II, norepinephrine and renal transport of electrolytes and water in normal man and in cirrhosis with ascites. J Clin Invest 1963;42:1179–1192.

    PubMed  CAS  Google Scholar 

  62. Cobden I, Shore A, Wilkinson R, Record CO. Captopril in the hepatorenal syndrome. J Clin Gastro-enterol 1985;7:354–360.

    Article  CAS  Google Scholar 

  63. Gentilini P, Romanelli RG, La Villa G, et al. Effects of low dose captopril on renal haemodynamics and function in patients with cirrhosis of the liver. Gastroenterology 1993;104:588–594.

    PubMed  CAS  Google Scholar 

  64. Pariente EA, Bataille C, Bercoff E, Lebrec D. Acute effects of captopril on systemic and renal haemodynamics and renal function in cirrhotic patients with ascites. Gastroenterology 1985;88:1255–1259.

    PubMed  CAS  Google Scholar 

  65. Wood LJ, Goergen S, Stockigt JR, et al. Adverse effects of captopril in treatment of resistant ascites, a state of functional bilateral renal artery stenosis. (Letter) Lancet 1985;2:1008–1009.

    Article  PubMed  CAS  Google Scholar 

  66. Schroeder ET, Anderson GH. Effect of blockade of angiotensin II on blood pressure, renin and aldosterone in cirrhosis. Kid Int 1976;9:511–519.

    Article  CAS  Google Scholar 

  67. Schneider AW, Kalk FJ, Klein CP. Effect of Losartan, an Angiotensin II receptor antagonist on portal pressure in cirrhosis. Hepatology 1999;29:334–339.

    Article  PubMed  CAS  Google Scholar 

  68. Garcia-Tsao G. Angiotensin II receptor antagonist in the pharmacological therapy: a caution. Gastroenterology 1999;117:740–742.

    Article  PubMed  CAS  Google Scholar 

  69. Epstein M. Renal prostaglandins and the control of renal function in liver disease. Am J Med 1986;80:46–61.

    Article  PubMed  CAS  Google Scholar 

  70. Guarner C, Colina I, Guarner F, Corzo J, Prieto J, Vilardi F. Renal prostaglandins in cirrhosis of the liver. Clin Sci 1986;70:477–484.

    PubMed  CAS  Google Scholar 

  71. Laffi G, La Villa G, Pinzani M, et al. Altered renal and platelet arachidonic acid metabolism in cirrhosis. Gastroenterology 1986;90:274–282.

    PubMed  CAS  Google Scholar 

  72. Rimola A, Gines P, Arroyo V, et al. Urinary excretion of 6-keto-prostaglandin Flalpha, thromboxane B2 and prostaglandin E2 in cirrhosis with ascites: relationship to functional renal failure (hepato-renal syndrome). J Hepatol 1986;3:111–117.

    Article  PubMed  CAS  Google Scholar 

  73. Zipser R, Hoefs J, Speckart P, Zia P, Horton R. Prostoglandins: modulators of renal function and pressor resistance in chronic liver disease. J Clin Endocrinol Metab 1979;48:895–900.

    Article  PubMed  CAS  Google Scholar 

  74. Boyer T, Zia P, Reynold T. Effect of indomethacin and prostaglandin A, on renal function and plasma renin activity in alcoholic liver disease. Gastroenterology 1979;77:215–222.

    PubMed  CAS  Google Scholar 

  75. Mullane IF, Gliedman ML. Elevation of the pressure in the abdominal inferior vena cava as a cause of a hepatorenal syndrome in cirrhosis. Surgery 1966;59:1135–1146.

    PubMed  CAS  Google Scholar 

  76. Henriksen JH. Hepatorenal disorders: role of the sympathetic nervous system. Sem Liver Dis 1994;14:35–43.

    CAS  Google Scholar 

  77. Zambraski EJ, DiBona GF. Sympathetic nervous system in hepatic cirrhosis. The kidney in the liver disease. Williams and Wilkins, Baltimore, 1988, pp. 469–485.

    Google Scholar 

  78. Bichet DG, Van Putten VJ, Schrier RW. Potential role of increased sympathetic activity in impaired sodium and water excretion in cirrhosis. N Engl J Med 1982;307:1552–1557.

    Article  PubMed  CAS  Google Scholar 

  79. Gaudin C, Braillon A, Poo JL, Moreau R, Hadengue A, Lebrec D. Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrhosis. J Hepatol 1991;13:161–168.

    Article  PubMed  CAS  Google Scholar 

  80. Henriksen JH, Ring-Larsen H, Christensen NJ. Kidney, lower limb, and whole-body uptake and release of catecholamines in alcoholic liver disease. Clin Physio1 1988;8:203–210.

    Article  CAS  Google Scholar 

  81. Henriksen JH, Christensen NJ, Ring-Larsen H. Noradrenaline and adrenaline concentrations in various vascular beds in patients with cirrhosis. Relation to haemodynamics. Clin Physiol 1981;1:293–304.

    PubMed  CAS  Google Scholar 

  82. Kostreva D, Castaner A, Kampine J. Reflex effects of hepatic baroreceptors on renal and cardiac sympathetic nerve activity. Am J Physiol 1980;238:R390–R394.

    PubMed  CAS  Google Scholar 

  83. Levy M, Wexler MJ. Hepatic denervation alters first-phase urinary sodium excretion in dogs with cirrhosis. Am J Physiol 1987;253:F664–F671.

    PubMed  CAS  Google Scholar 

  84. Lang F, Tschernko E, Schulze E, et al. Hepatorenal reflex regulating kidney function. Hepatology 1991;14:590–594.

    Article  PubMed  CAS  Google Scholar 

  85. Jalan R, Forrest EH, Redhead DN, Hayes PC. Reduction in renal blood flow with acute increase of portal pressure gradient. Evidence for the hepatorenal reflex? Hepatology 1994;20.

    Google Scholar 

  86. Solis-Herruzo JA, Duran A, Favelza V, et al. Effects of lumbar sympathetic block on kidney function in cirrhotic patients with hepatorenal syndrome. J Hepatol 1987;5:167–173.

    Article  PubMed  CAS  Google Scholar 

  87. Ring-Larsen H. Renal blood flow in cirrhosis: relation to systemic and portal haemodynamics and liver function. Scand J Clin Lab Invest 1977;37:635–642.

    PubMed  CAS  Google Scholar 

  88. Uchihara M, Izumi N, Sato C, Marumo F. Clinical significance of elevated plasma endothelin concentration in patients with cirrhosis. Hepatology 1992;16:95–99.

    Article  PubMed  CAS  Google Scholar 

  89. Moore K, Wendon J, Frazer M, Karani J, Williams R, Badr K. Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome. N Engl J Med 1992;327:1774–1778.

    Article  PubMed  CAS  Google Scholar 

  90. Morrow JD, Moore KP, Awad JA, et al. Marked overproduction non-cyvclooxygenase derives prostanoids (F2-isoprostanes) in the hepatorenal syndrome. J Lipid Mediators 1993;6:417–420.

    CAS  Google Scholar 

  91. Boulanger CM, Tanner FC, Bea ML, Hahn AW, Werner A, Luscher TF. Oxidized low density lipoproteins induce mRNA expression and release of endothelin from human and porcine endothelium. Circ Res 1992;70:1191–1197.

    PubMed  CAS  Google Scholar 

  92. Yura T, Fukunaga M, Khan R, Nassar GN, Badr KF, Montero A. Free-radical-generated F2-iso-prostane stimulates cell proliferation and endothelin-1 expression on endothelial cells. Kidney Int 1999;56:471–478.

    Article  PubMed  CAS  Google Scholar 

  93. Vaughan RB, Angus PW, Chin-Dusting JP. Evidence for altered vascular responses to exogenous endothelin-1 in patients with advanced cirrhosis with restoration of the normal vasoconstrictor response following successful liver transplantation. Gut 2003;52:1505–1510.

    Article  PubMed  CAS  Google Scholar 

  94. Moore KP, Taylor GW, Gove C, et al. Synthesis and metabolism of cysteinyl leukotrienes by the isolated pig kidney. Kid Int 1992;41:1543–1548.

    Article  CAS  Google Scholar 

  95. Moore KP, Taylor GW, Maltby NH et al. Increased production of cysteinyl leukotrienes in hepatorenal syndrome. J Hepatol 1990;11:263–271.

    Article  PubMed  CAS  Google Scholar 

  96. Uemura M, Buchholz U, Kojima H, et al. Cysteinyl leukotrienes in the urine of patients with liver diseases. Hepatology 1994;20:804–812.

    Article  PubMed  CAS  Google Scholar 

  97. Huber M, Kastner S, Scholmerich J, Gerok W, Keppler D. Analysis of cysteinyl leukotrienes in human urine: enhanced excretion in patients with liver cirrhosis and hepatorenal syndrome. Europ J Clin Invest 1989;19:53–60.

    PubMed  CAS  Google Scholar 

  98. Zipser RD, Radvan GH, Kronborg IJ, Duke R, Little TE. Urinary thromboxane B2 and prostaglandin E2 in the hepatorenal syndrome: evidence for increased vasoconstrictor and decreased vasodilator factors. Gastroenterology 1983;84:697–703.

    PubMed  CAS  Google Scholar 

  99. Zipser RD, Kronborg I, Rector W, Reynolds T, Daskalopoulos G. Therapeutic trial of thromboxane synthesis inhibition in the hepatorenal syndrome. Gastroenterology 1984;87:1228–1232.

    PubMed  CAS  Google Scholar 

  100. Guha IN, Moore K. F2-isoprostanes and the liver. Prostaglandins and other Lipid Mediators 2003;72:73–84.

    Article  PubMed  CAS  Google Scholar 

  101. Goulis J, Patch D, Burroughs AK. Bacterial infection in the pathogenesis of variceal bleeding. Lancet 1999;353:139–142.

    Article  PubMed  CAS  Google Scholar 

  102. Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403–409.

    Article  PubMed  CAS  Google Scholar 

  103. Gines P, Tito L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;84:1493–1502.

    Google Scholar 

  104. Gines P, Fcmandcz-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002–1010.

    Article  PubMed  CAS  Google Scholar 

  105. Cabrera J, Arroyo V, Ballesta AM, et al. Aminoglycoside toxicity in cirrhosis. Value of urinary beta-2 microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 1982;82:97–105.

    PubMed  CAS  Google Scholar 

  106. Martin G, Bennett-Guerrero E, Wakeling H, et al. A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer’s solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery. J Cardiothorac Vase Anesth 2002;16:441–446

    Article  CAS  Google Scholar 

  107. Hadengue A, Moreau R, Gaudin C, Bacq Y, Champigneulle B, Lebrec D. Total effective vascular compliance in patients with cirrhosis: a study of the response to acute blood volume expansion. Hepatology 1992;15:809–815.

    Article  PubMed  CAS  Google Scholar 

  108. Ortega R, Gines P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 2002;36:941–948.

    PubMed  CAS  Google Scholar 

  109. Moreau R, Durand F, Poynard T, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology 2002;122:923–930.

    Article  PubMed  CAS  Google Scholar 

  110. Solanki P, Chawla A, Garg R, Gupta R, Jain M, Sarin SK. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J Gastroenterol Hepatol 2003;18:152–156.

    Article  PubMed  CAS  Google Scholar 

  111. Duvoux C, Zanditenas D, Hezode C, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study. Hepatology 2002;36:374–380.

    Article  PubMed  CAS  Google Scholar 

  112. Panos MZ, Moore K, Vlavianos P, et al. Single, total paracentesis for tense ascites: sequential hemodynamic changes and right atrial size. Hepatology 1990;11:662–667.

    Article  PubMed  CAS  Google Scholar 

  113. Holt S, Marley R, Fernando B, Harry D, Moore K. Improvement of renal function in hepatorenal syndrome with N-acetyl cysteine. Lancet 1999;353:294.

    Article  PubMed  CAS  Google Scholar 

  114. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann I), Zidek W. Prevention of radio-graphic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180–184.

    Article  PubMed  CAS  Google Scholar 

  115. Mitzner S, Stange J, Klammt S, et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled trial. Liver Transplantation 2000;6:277–286.

    Article  PubMed  CAS  Google Scholar 

  116. Ochs A, Rossle M, Haag K, et al. The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 1995;332:1192–1197.

    Article  PubMed  CAS  Google Scholar 

  117. 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.

    Article  PubMed  CAS  Google Scholar 

  118. Gonwa TA, Morris CA, Goldstein RM, Husberg BS, Klinthalm GB. Long-term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome-experience in 300 patients. Transplantation 1991;51:428–430.

    Article  PubMed  CAS  Google Scholar 

  119. Le Moine O. Hepatorenal syndrome outcome after liver transplantation. Nephrology, Dialysis Transplant 1998;13:20–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Moore, K. (2005). Diagnosis and Management of the Hepatorenal Syndrome. In: Sanyal, A.J., Shah, V.H. (eds) Portal Hypertension. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59259-885-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-885-4_22

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-386-2

  • Online ISBN: 978-1-59259-885-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics