21/32. 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 = 1keywords = syndrome (Clic here for more details about this article) |
22/32. hepatorenal syndrome: resolution after transjugular intrahepatic portosystemic shunt.hepatorenal syndrome (HRS), a functional renal failure associated with severe liver disease, is believed to result from diminished effective arterial volume and altered renal hemodynamics. death is almost inevitable after its development and therapeutic options are limited. Surgical shunts carry an increase in morbidity and mortality, and peritoneovenous shunts are frequently complicated by infection and coagulopathy. We report a case of hepatorenal syndrome successfully treated with transjugular intrahepatic portosystemic shunt (TIPS). This is an unusual therapeutic option for HRS and may lead to future indications for TIPS.- - - - - - - - - - ranking = 1keywords = syndrome (Clic here for more details about this article) |
23/32. hepatorenal syndrome. Long-term treatment with terlipressin as a bridge to liver transplantation.In patients with hepatorenal syndrome (HRS), 4-hr administration of a vasopressin analog has recently been shown to benefit renal blood flow and renal function. However, long-term effects and tolerance of this treatment have not been reported. We report a case of HRS that was controlled by the vasopressin analog, terlipressin. Because HRS repeatedly relapsed when treatment was discontinued, terlipressin, 2 mg/day was administered for 67 days, until liver transplantation could be performed in a patient with normal renal function. Except for limited cutaneous necrosis at an injection point, prolonged treatment with this vasopressin analog was well tolerated.- - - - - - - - - - ranking = 0.83333333333333keywords = syndrome (Clic here for more details about this article) |
24/32. Extensive white matter involvement in hemorrhagic shock and encephalopathy syndrome.Reported is a case of hemorrhagic shock and encephalopathy syndrome (HSE) with extensive white matter involvement. A three year old, previously healthy boy was presented with an acute onset of fever, loss of consciousness and convulsions. He had disseminated intravascular coagulation, metabolic acidosis, non-ketotic hypoglycemia and hepatorenal dysfunction. The computed tomography (CT) scan of his head on the second day of illness demonstrated symmetric, extensive low-density areas in the cerebral and cerebellar white matter. The child died on the 13th hospital day. A post-mortem histopathological examination of the liver revealed centrilobular necrosis and infiltration of fatty acid droplets. The concentrations of serum 2',5'-oligoadenylate synthetase and urinary neopterin were markedly elevated, indicating excessively activated cell-mediated immunity. This overproduction of inflammatory cytokines might play an important role in the pathogenesis of the brain lesion as well as in other clinical and laboratory manifestations. The patient had a decreased serum level of alpha l-antitrypsin, which may have been associated with the development of uncontrolled inflammation and coagulation disorder.- - - - - - - - - - ranking = 0.83333333333333keywords = syndrome (Clic here for more details about this article) |
25/32. Acute renal failure complicating non-fulminant hepatitis a.Hepatitis, A is usually a mild and self-limiting infection of the liver. Whereas the clinical course is usually benign in children, complications such as prolonged cholestasis and fulminant liver failure have been reported in adults. Acute functional renal failure is an uncommon event in the absence of fulminating liver disease. So far, only cases of acute hepatitis a with biopsy-proven interstitial renal disease or tubular necrosis have been reported [Geltner et al. 1992. Kramer et al. 1986]. We present the case of a 35-year-old, previously healthy male with non-fulminant cholestatic viral hepatitis a, who developed progressive oliguric renal failure requiring dialysis therapy. kidney biopsy ruled out glomerular disease and tubular necrosis. In the absence of bleeding and other causes of fluid depletion this case may be another variant of hepatorenal syndrome whose etiopathogenesis is only poorly understood.- - - - - - - - - - ranking = 0.16666666666667keywords = syndrome (Clic here for more details about this article) |
26/32. Sequential treatment of hepatorenal syndrome and posthepatic cirrhosis by intrahepatic portosystemic shunt (TIPSS) and liver transplantation.The results of liver transplantation are compromised in cirrhotic patients presenting with renal insufficiency from hepatorenal syndrome. A case of cirrhosis and hepatorenal syndrome, treated sequentially with transjugular intrahepatic porto-systemic stent shunting (TIPSS) and liver transplantation, is discussed. TIPSS may be useful for correcting renal dysfunction and/or hepatorenal syndrome in end-stage cirrhotics, thus permitting subsequent elective liver transplantation under good conditions.- - - - - - - - - - ranking = 1.1666666666667keywords = syndrome (Clic here for more details about this article) |
27/32. Spontaneous recovery of post partus liver necrosis in a patient listed for transplantation.The patient was a young previously healthy woman, who after a normal grosses, during delivery got severe abdominal pain. The liver function tests were highly pathological and the patient became anuric and developed first grade of encephalopathy. In computer tomography, 90% of the liver parenchyma was damaged and liver biopsy showed necrosis. The patient had fulminant hepatic failure including hepatorenal syndrome and was put on the Scandiatransplant high urgent waiting list for a liver transplant. No suitable liver was found. After eight days, the general situation of the patient was better and the liver function tests started to improve. She was taken off the waiting list. Twenty-seven days after delivery the patient was discharged in good condition. At check up six months later the patient was feeling well and the clinical tests were normal.- - - - - - - - - - ranking = 0.16666666666667keywords = syndrome (Clic here for more details about this article) |
28/32. 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 = 0.16666666666667keywords = syndrome (Clic here for more details about this article) |
29/32. Terlipressin may influence the outcome of hepatorenal syndrome complicating alcoholic hepatitis.hepatorenal syndrome is a frequent complication associated with extremely short survival in cirrhotic patients with alcoholic hepatitis. Vasopressin analogs have been reported to induce transient regression of hepatorenal syndrome in patients with cirrhosis. However, treatment withdrawal was followed by early recurrences in every case. We report the case of a 68-yr-old woman with severe alcoholic hepatitis complicated by hepatorenal syndrome. Terlipressin induced a prolonged recovery of renal function that was associated with improvement in hepatic function.- - - - - - - - - - ranking = 1.1666666666667keywords = syndrome (Clic here for more details about this article) |
30/32. Primary induction with mycophenolate mofetil and corticosteroids in a liver transplant recipient with hepatorenal syndrome.OBJECTIVE: To report the use of mycophenolate mofetil for primary induction in a liver transplant recipient to avoid the nephrotoxicity of cyclosporine/tacrolimus. CASE SUMMARY: A 47-year-old white man in a hepatic coma with anuric hepatorenal syndrome received a liver transplant, and was given mycophenolate mofetil and corticosteroids as primary induction immunosuppression with the addition of low-dose cyclosporine 13 days later. His renal function improved and he remains rejection-free after 13 months of follow-up. CONCLUSIONS: This case suggests that mycophenolate mofetil may be used as a primary induction agent in liver transplant recipients with renal failure to avoid the additional nephrotoxicity of the standard immunosuppressants, cyclosporine and tacrolimus. Low-dose cyclosporine/tacrolimus may be introduced later as the renal function improves.- - - - - - - - - - ranking = 0.83333333333333keywords = syndrome (Clic here for more details about this article) |
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