1/8. Is spontaneous bacterial peritonitis an inducer of vasopressin analogue side-effects? A case report.In recent years, the use of vasopressin analogues in the treatment of hepatorenal syndrome has become an effective therapeutic strategy leading to improved survival and often allowing the completion of liver transplantation. Terlipressin, in particular, has proven to be safe and effective. Due to the limited number of patients treated so far, it is, however, difficult to draw any definite conclusions on the optimal dosage and on the occurrence of side-effects in these patients. The case is reported of an ascitic cirrhotic patient who developed spontaneous bacterial peritonitis followed by a type-I hepatorenal syndrome. Treatment with terlipressin boluses (0.5 mg/4 h) associated with albumin infusion was then started. The course of the disease was monitored by clinical and laboratory means. After 10 boluses of terlipressin, rectorrhagia and severe ischaemic complications involving the skin of the abdomen, lower limbs, scrotus, and penis, occurred. These ischaemic complications improved after terlipressin withdrawal, while renal failure evolved leading to the patient's death. This case report shows that, in patients with type-I hepatorenal syndrome, the use of terlipressin, even at low dosages, may induce life-threatening ischaemic complications and, moreover, suggests that the recent occurrence of spontaneous bacterial peritonitis, even if properly treated, may significantly increase the risk of major ischaemic complications.- - - - - - - - - - ranking = 1keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
2/8. hepatorenal syndrome: resolution of ascites by continuous renal replacement therapy in an alcoholic coinfected with hepatitis b, C, and human immunodeficiency viruses.A 39-yr-old male with hepatorenal syndrome type 1 and refractory ascites was treated with continuous renal replacement therapy (CRRT) resulting in clinical improvement. He was positive for antibodies to hepatitis b, C, and human immunodeficiency viruses, and had a history of chronic alcohol and iv drug abuse. The patient had 4 hospital admissions during a 12-wk period. He first presented with advanced liver disease including pedal edema and a serum ammonia level of 56 micromol/L (reference range: 11 - 35 micromol/L). In subsequent admissions, he had asterixis, nausea, vomiting, jaundice, and worsening pedal edema. On his 4th admission, there was lethargy, tense ascites, decreased urinary output, bilateral edema of the lower extremities and scrotum, serum creatinine of 6.2 mg/dl (reference range: 0.6 - 1.5 mg/dl), and weight gain of 16 kg during the prior 8 wk. During the first 3 hospitalizations, he was treated with lactulose with slight improvement. On the 4th admission, he was started on low-dose dopamine (3 microg/kg/min) and 25% salt-poor albumin without clinical improvement. A pulmonary artery catheter was placed and hemofiltration by CRRT was performed for 5 days, with removal of 26.7 L of fluid and a net reduction of 11 kg of body weight. serum creatinine decreased to 4.2 mg/dl during CRRT and was 2.2 mg/dl at hospital discharge 2 weeks later. His PaO(2) improved from 66 to 78 mmHg and his systemic vascular resistance increased from 571 to 799 dyne.sec/cm(5). CRRT was effective in relieving severe fluid retention and producing marked clinical improvement. We suggest that CRRT should be considered for the treatment of refractory ascites including that caused by hepatorenal syndrome.- - - - - - - - - - ranking = 0.66666666666667keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
3/8. Peritoneovenous (LeVeen) shunt. Control of renin-aldosterone system in cirrhotic ascites.Because of the unusual clinical course of a patient with hepatic cirrhosis, refractory ascites, and hepatorenal syndrome, we were able to examine the complex interrelationships between massive ascites, renin-aldosterone activity, and renal and hepatic function before and after placement of a peritoneojugular vein (LeVeen) shunt. Measurements indicated that when the shunt was functioning, renin-aldosterone production was suppressed, the hepatorenal syndrome was reversed, and ascites remitted. These data suggest that hyperreninemia, hyperaldosteronism, and functional renal abnormalities of this disorder are potentially reversible and arise primarily from the imbalance between formation and drainage of hepatosplanchnic lymph rather than from hepatocellular dysfunction, lowered plasma oncotic pressure, or portal hypertension.- - - - - - - - - - ranking = 0.66666666666667keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
4/8. Improvement of renal failure with repeated head-out water immersions in patients with hepatorenal syndrome associated with alcoholic hepatitis.Two patients with severe hepatorenal syndrome associated with alcoholic hepatitis are reported, in whom repeated daily courses of head-out water immersion were dramatically effective in producing an improvement of the renal function. Using repeated 2-hour courses of head-out water immersion for 7 days in the 1st patient, an immediate increase in urine output was observed. A slight increase in renal sodium excretion was also noted. The patient lost 7 kg over 1 week. serum creatinine decreased from 520 to 370 mumol/l, and the renal function continued to improve thereafter. In the 2nd patient, repeated head-out water immersion was associated with a progressive improvement of the renal function, an effect that was absent during an initial therapy of volume load. The acute effects of immersion in in this 2nd patient were characterized by a dramatic increase in urine output and renal sodium excretion as well as in p-aminohippurate and creatinine clearances. These effects were associated with a decrease in the activity of the renin-angiotensin system and a modest increase in plasma atrial natriuretic peptide levels. Thus, these 2 cases emphasize the potential benefits of repeated head-out water immersions in improving the renal function of patients with hepatorenal syndrome.- - - - - - - - - - ranking = 2keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
5/8. Hepatic hydrothorax without diaphragmatic defect. An original surgical treatment.A 58-year-old woman with a long history of well-compensated postnecrotic cirrhosis with acute massive ascites and right-sided pleural effusion was admitted. The injection of colorant and radioactive material into the peritoneal cavity didn't show up any passage through the diaphragm. After resuscitation therapy and insertion of abdominal and chest tube, effusions rapidly and massively re-accumulated. A LeVeen peritoneovenous shunt was inserted as an emergency measure owing to hepatorenal syndrome. ascites completely resolved but pleural effosion was continuously and severely recharged. A Denver inverted shunt was subcutaneously inserted from pleural to peritoneal cavity. After operation CPAP was applied and pump device activated; pleural effusion gradually disappeared clearing completely the pleural space. The patient was discharged on the 10th postoperative day; her general condition and laboratory test have remained satisfactory up to one year without ascites and pleural effusion.- - - - - - - - - - ranking = 0.33333333333333keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
6/8. hepatorenal syndrome: reversal by peritoneovenous shunt.Two patients with hepatorenal syndrome were treated by insertion of a peritoneovenous shunt. The renal deficit was corrected rapidly in both cases. A 62-year-old woman with a slow onset syndrome with urine output of 100 to 150 ml/day and urinary sodium excretion of 1 mEq/day responded with large volume urinary output and sodium excretion. She is alive with minimal ascites 18 months after shunt. A 53-year-old man with severe nutritional cirrhosis, alcoholic hepatitis, and eventual massive necrosis was treated for bleeding esophageal varices by portacaval shunt. Postoperative massive ascites progressed to acute hepatorenal syndrome. Insertion of a peritoneovenous shunt reversed the renal deficit. HE eventually exsanguinated due to a hemorrhagic diathesis caused by massive hepatic necrosis.- - - - - - - - - - ranking = 0.66666666666667keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
7/8. hepatorenal syndrome. Recovery after peritoneovenous shunt.The renal failure in the hepatorenal syndrome is unusual because the kidneys are histologically normal and the renal failure may be "functional." Hemodynamic studies indicate that increased renal vascular resistance and decreased renal blood flow may be the primary abnormalities leading to renal failure in some cases. This report describes a patient whose renal failure resolved after placement of a peritoneovenous shunt. A major advantage of this device is that it can be inserted with the patient under local anesthesia with minimal surgical risk. Further studies are needed to define the role of the peritoneovenous shunt in the hepatorenal syndrome.- - - - - - - - - - ranking = 0.66666666666667keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
8/8. Management of ascites in the patient with portal hypertension with emphasis on spontaneous bacterial peritonitis.The reintroduction of paracentesis has modified the way in which patients with ascites are treated. Transjugular intrahepatic portosystemic shunt can be an alternative treatment for patients with refractory ascites and for those patients with hepatorenal syndrome, although more studies are needed to clarify its usefulness and safety. The use of more potent and less nephrotoxic antibiotics together with an earlier diagnosis have improved the outcome of patients with spontaneous bacterial peritonitis (SBP). Oral antibiotics can be used in patients with SBP and good clinical conditions with an efficacy similar to that obtained with intravenous antibiotics. Prophylactic antibiotics in SBP should be restricted to cirrhotic patients at high risk, including bleeding cirrhotic patients, those with a past history of SBP, and those with low protein content in ascitic fluid. This chapter describes the management of ascites in patients with portal hypertension.- - - - - - - - - - ranking = 0.33333333333333keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |