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Year 2014, Volume: 4 Issue: 2, 106 - 113, 02.08.2014

Abstract

Hepatorenal syndrome (HRS) is functional renal failure that occurs with advanced liver failure. HRS is considered the most severe complication of cirrhosis. Type 1 HRS develops due to severe reduction of effective circulating volume results in hemodynamic dysfunction. Type 1 HRS is characterized by acute renal failure and rapid deterioration in the function of other organs. It can occur spontaneously or in the setting of a precipitating event. Type 2 hepatorenal syndrome (HRS), which is characterized by slowly progressive renal failure and refractory ascites. Liver transplantation is the only definitive treatment for both types. The most suitable “bridge treatments” or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.

References

  • Arroyo, V. & Colmenero, J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J. Hepatol 2003; 38 (Suppl. 1): S69-S89.
  • Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of hepatorenal syndrome in cirrhosis. Gastroenterology 1993;105:229–236.
  • Arroyo V, . & Fernández J. .Manegement of hepatorenal syndrome in patients with cirrhosis. Nat. Rev. Nephrol 2011;7: 517-526.
  • Schrier RW, Arroyo V, Bernardi M, et al. Peripheral arterial vasodilation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8: 1151– 1157.
  • Arroyo V, Clària J, Saló J, et al. Antidiuretic hormone and the pathogenesis of water retention in cirrhosis with ascites. Semin Liver Dis 1994; 14: 44– 58.
  • Iversen, P, Sørensen M, Bak LK, et al. Low cerebral oxygen consumption and blood flow in patients with cirrhosis and an acute episode of hepatic encephalopathy. Gastroenterology 2009;136: 863-871.
  • Moore K. Arachidonic acid metabolites and the kidney in cirrhosis. In: Arroyo V, Ginès P, Rodés J, Schrier RW, eds. Ascites and renal dysfunction in liver disease. Malden ( MA): Blackwell Science, 1999: 249– 272.
  • 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: 1495–501.
  • Sacerdoti D, Merkel C, Bolognesi M et al. Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationships with portal hemodynamics. Gastroenterology 1995;108: 1152-1158.
  • Ruiz-del-Arbol L, Monescillo A, Arocena C et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology 2005;42: 439-447.
  • Cárdenas A, Ginès P, Uriz J, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology 2001;34: 671-676.
  • Ginés P, Arroyo V, Quintero E et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology 1987; 93: 234-241.
  • European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J. Hepatol 2010; 53: 397-417.
  • Moore KP, Wong F, Gines P et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38: 258-266.
  • Navasa M, Follo A, Filella X et al. Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality. Hepatology 1998; 27: 1227-1232.
  • Fasolato S, Angeli P, Dallagnese L et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology 2007; 45: 223-229.
  • Arroyo V, Ginès P, Gerbes A, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996; 23: 164– 76.
  • Wong F. Liver and kidney diseases. Clin Liver Dis 2002; 6: 981-1011.
  • Arroyo V, Cardenas A, Campistol JM et al. Acute renal failure in liver disease. In: Davison A, Stewart CJ, Grunfeld JP, Kerr DNS, Ritz E, Winearls CG. Oxford textbook of clinical hepatology. London: Oxford Press, 2005: 1564-79.
  • Salerno F, Gerbes A, Ginès P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56: 1310-1318.
  • Duseja A. Chawla YK, Dhiman RK et al. Non-hepatic insults are common acute precipitants in patients with acute on chronic liver failure (ACLF). Dig. Dis. Sci 2010; 55: 3188-3192.
  • Lata J. Hepatorenal syndrome World J Gastroenterol 2012; 28: 18(36):4978-4984.
  • Gonwa, TA, Morris, CA, Goldstein RM et al. 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.
  • Gonwa, TA, McBride MA, Anderson K, et al. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am. J. Transplant 2006; 6: 2651-2659.
  • Crawford, DH, Endre ZH, Axelsen RA et al. Universal occurrence of glomerular abnormalities in patients receiving liver transplants. Am. J. Kidney Dis 1992; 19: 339-344.
  • Portal AJ, Austin M, Heneghan MA. Novel approaches to assessing renal function in cirrhotic liver disease. Hepatol Res 2007; 37: 667-72.
  • Orlando R, Mussap M, Plebani M et al. Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis. Clin Chem 2002; 48: 850–8.
  • Gerbes AL, Gulberg V, Bilzer M, et al. Evaluation of serum cystatin C concentration as a marker of renal function in patients with cirrhosis of the liver. Gut 2002; 50: 106–10.
  • Lluch P, Mauricio MD, Vila JM et al. Accumulation of symmetric dimethylarginine in hepatorenal syndrome. Exp Biol Med (Maywood) 2006; 231: 70–5.
  • Vaidya VS, Ramirez V, Ichimura T, et al. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury. Am J Physiol Renal Physiol 2006; 290: F517–29.
  • Mishra J, Ma Q, Prada A et al. Identification of neutrophil gelatinase- associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003; 14: 2534–43.
  • Cabrera J, Arroyo V, Ballesta AM et al. Aminoglycoside nephrotoxicity in cirrhosis. Value of urinary beta -microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 1982; 82: 97-105.
  • Malyszko, J. Biomarkers of acute kidney injury in different clinical settings: a time to change the paradigm? Kidney Blood Press. Res 2010; 33: 368-382.
  • Ginès, P. Titó L, Arroyo V et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94: 1493-1502.
  • Ginès A. Fernández-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.
  • Runyon, BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087-2107.
  • Solanki P, Chawla A, Garg R et al. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J. Gastroenterol. Hepatology 2003;18: 152-156.
  • Gluud LL, Christensen K, Christensen E. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-584.
  • Nazar A. Pereira GH, Guevara M et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2010; 51: 219-226.
  • Nadim MK, Kellum JA, Davenport A et al. Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2012; 16: R23.
  • Gines P. Pharmacological manegement of hepatorenal syndrome:lessons from nonresponders. J Hepatol 2011; 55: 268-269.
  • Sharma P, Kumar A, Shrama BC et al. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am. J. Gastroentero. 2008; 103: 1689-1697.
  • Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2004; 40: 55-64.
  • 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.
  • Testino G, Ferro C, Sumberaz A et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology 2003; 50: 1753-1755.
  • Hassanein TI, Tofteng F, Brown RS Jr et al. Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology 2007; 46: 1853-1862.

Hepatorenal Sendrom (HRS)

Year 2014, Volume: 4 Issue: 2, 106 - 113, 02.08.2014

Abstract

Kronik karaciğer hastalığı zemininde ortaya çıkan morfolojik olarak böbreklerin sağlam olduğu ancak fonksiyonel böbrek yetmezliği tablosu hepatorenal sendrom (HRS) olarak tanımlanır. HRS kötü prognozu nedeniyle sirozun en korkulan komplikasyonudur.

Kronik karaciğer hastalığı zemininde efektif arteriyel kan hacminde azalma ağır hemodinamik değişikliklerle sonuçlanır. Tip 1 HRS aniden gelişen akut böbrek yetmezliği ve diğer organ sistem fonksiyon bozuklukları ile birliktedir. Tip 1 HRS spontan şekilde gelişebilmesine karşın diğer tetikleyici nedenler sonucunda da gelişebilmektedir. Tip 2 HRS siroz ve portal hipertansiyon nedeniyle böbrek fonksiyonlarında yavaş ve ilerleyici azalma ile karakterizedir ve refrakter asit söz konusudur. Karaciğer nakli her iki tip HRS içinde kesin tedavidir. Karaciğer nakli yapılana kadar veya nakil yapılmaya uygun olmayan hastalar için en uygun köprü tedavi terlipresin ve albumin kombinasyonudur.

References

  • Arroyo, V. & Colmenero, J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J. Hepatol 2003; 38 (Suppl. 1): S69-S89.
  • Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of hepatorenal syndrome in cirrhosis. Gastroenterology 1993;105:229–236.
  • Arroyo V, . & Fernández J. .Manegement of hepatorenal syndrome in patients with cirrhosis. Nat. Rev. Nephrol 2011;7: 517-526.
  • Schrier RW, Arroyo V, Bernardi M, et al. Peripheral arterial vasodilation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8: 1151– 1157.
  • Arroyo V, Clària J, Saló J, et al. Antidiuretic hormone and the pathogenesis of water retention in cirrhosis with ascites. Semin Liver Dis 1994; 14: 44– 58.
  • Iversen, P, Sørensen M, Bak LK, et al. Low cerebral oxygen consumption and blood flow in patients with cirrhosis and an acute episode of hepatic encephalopathy. Gastroenterology 2009;136: 863-871.
  • Moore K. Arachidonic acid metabolites and the kidney in cirrhosis. In: Arroyo V, Ginès P, Rodés J, Schrier RW, eds. Ascites and renal dysfunction in liver disease. Malden ( MA): Blackwell Science, 1999: 249– 272.
  • 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: 1495–501.
  • Sacerdoti D, Merkel C, Bolognesi M et al. Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationships with portal hemodynamics. Gastroenterology 1995;108: 1152-1158.
  • Ruiz-del-Arbol L, Monescillo A, Arocena C et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology 2005;42: 439-447.
  • Cárdenas A, Ginès P, Uriz J, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology 2001;34: 671-676.
  • Ginés P, Arroyo V, Quintero E et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology 1987; 93: 234-241.
  • European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J. Hepatol 2010; 53: 397-417.
  • Moore KP, Wong F, Gines P et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38: 258-266.
  • Navasa M, Follo A, Filella X et al. Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality. Hepatology 1998; 27: 1227-1232.
  • Fasolato S, Angeli P, Dallagnese L et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology 2007; 45: 223-229.
  • Arroyo V, Ginès P, Gerbes A, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996; 23: 164– 76.
  • Wong F. Liver and kidney diseases. Clin Liver Dis 2002; 6: 981-1011.
  • Arroyo V, Cardenas A, Campistol JM et al. Acute renal failure in liver disease. In: Davison A, Stewart CJ, Grunfeld JP, Kerr DNS, Ritz E, Winearls CG. Oxford textbook of clinical hepatology. London: Oxford Press, 2005: 1564-79.
  • Salerno F, Gerbes A, Ginès P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56: 1310-1318.
  • Duseja A. Chawla YK, Dhiman RK et al. Non-hepatic insults are common acute precipitants in patients with acute on chronic liver failure (ACLF). Dig. Dis. Sci 2010; 55: 3188-3192.
  • Lata J. Hepatorenal syndrome World J Gastroenterol 2012; 28: 18(36):4978-4984.
  • Gonwa, TA, Morris, CA, Goldstein RM et al. 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.
  • Gonwa, TA, McBride MA, Anderson K, et al. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am. J. Transplant 2006; 6: 2651-2659.
  • Crawford, DH, Endre ZH, Axelsen RA et al. Universal occurrence of glomerular abnormalities in patients receiving liver transplants. Am. J. Kidney Dis 1992; 19: 339-344.
  • Portal AJ, Austin M, Heneghan MA. Novel approaches to assessing renal function in cirrhotic liver disease. Hepatol Res 2007; 37: 667-72.
  • Orlando R, Mussap M, Plebani M et al. Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis. Clin Chem 2002; 48: 850–8.
  • Gerbes AL, Gulberg V, Bilzer M, et al. Evaluation of serum cystatin C concentration as a marker of renal function in patients with cirrhosis of the liver. Gut 2002; 50: 106–10.
  • Lluch P, Mauricio MD, Vila JM et al. Accumulation of symmetric dimethylarginine in hepatorenal syndrome. Exp Biol Med (Maywood) 2006; 231: 70–5.
  • Vaidya VS, Ramirez V, Ichimura T, et al. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury. Am J Physiol Renal Physiol 2006; 290: F517–29.
  • Mishra J, Ma Q, Prada A et al. Identification of neutrophil gelatinase- associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003; 14: 2534–43.
  • Cabrera J, Arroyo V, Ballesta AM et al. Aminoglycoside nephrotoxicity in cirrhosis. Value of urinary beta -microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 1982; 82: 97-105.
  • Malyszko, J. Biomarkers of acute kidney injury in different clinical settings: a time to change the paradigm? Kidney Blood Press. Res 2010; 33: 368-382.
  • Ginès, P. Titó L, Arroyo V et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94: 1493-1502.
  • Ginès A. Fernández-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.
  • Runyon, BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087-2107.
  • Solanki P, Chawla A, Garg R et al. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J. Gastroenterol. Hepatology 2003;18: 152-156.
  • Gluud LL, Christensen K, Christensen E. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-584.
  • Nazar A. Pereira GH, Guevara M et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2010; 51: 219-226.
  • Nadim MK, Kellum JA, Davenport A et al. Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2012; 16: R23.
  • Gines P. Pharmacological manegement of hepatorenal syndrome:lessons from nonresponders. J Hepatol 2011; 55: 268-269.
  • Sharma P, Kumar A, Shrama BC et al. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am. J. Gastroentero. 2008; 103: 1689-1697.
  • Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2004; 40: 55-64.
  • 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.
  • Testino G, Ferro C, Sumberaz A et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology 2003; 50: 1753-1755.
  • Hassanein TI, Tofteng F, Brown RS Jr et al. Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology 2007; 46: 1853-1862.
There are 46 citations in total.

Details

Primary Language Turkish
Journal Section Review Article
Authors

Ebru Yılmaz This is me

Nida Dinçel

İpek Kaplan Bulut This is me

Sevgi Mir This is me

Publication Date August 2, 2014
Published in Issue Year 2014 Volume: 4 Issue: 2

Cite

APA Yılmaz, E., Dinçel, N., Kaplan Bulut, İ., Mir, S. (2014). Hepatorenal Sendrom (HRS). Çağdaş Tıp Dergisi, 4(2), 106-113.
AMA Yılmaz E, Dinçel N, Kaplan Bulut İ, Mir S. Hepatorenal Sendrom (HRS). J Contemp Med. August 2014;4(2):106-113.
Chicago Yılmaz, Ebru, Nida Dinçel, İpek Kaplan Bulut, and Sevgi Mir. “Hepatorenal Sendrom (HRS)”. Çağdaş Tıp Dergisi 4, no. 2 (August 2014): 106-13.
EndNote Yılmaz E, Dinçel N, Kaplan Bulut İ, Mir S (August 1, 2014) Hepatorenal Sendrom (HRS). Çağdaş Tıp Dergisi 4 2 106–113.
IEEE E. Yılmaz, N. Dinçel, İ. Kaplan Bulut, and S. Mir, “Hepatorenal Sendrom (HRS)”, J Contemp Med, vol. 4, no. 2, pp. 106–113, 2014.
ISNAD Yılmaz, Ebru et al. “Hepatorenal Sendrom (HRS)”. Çağdaş Tıp Dergisi 4/2 (August 2014), 106-113.
JAMA Yılmaz E, Dinçel N, Kaplan Bulut İ, Mir S. Hepatorenal Sendrom (HRS). J Contemp Med. 2014;4:106–113.
MLA Yılmaz, Ebru et al. “Hepatorenal Sendrom (HRS)”. Çağdaş Tıp Dergisi, vol. 4, no. 2, 2014, pp. 106-13.
Vancouver Yılmaz E, Dinçel N, Kaplan Bulut İ, Mir S. Hepatorenal Sendrom (HRS). J Contemp Med. 2014;4(2):106-13.