1/6. Successful treatment of hepatic hydrothorax with octreotide.Hepatic hydrothorax is a rare complication of cirrhosis. Controlling ascites formation is the goal of therapy. We report the case of an adult patient presenting with alcoholic cirrhosis who developed first a symptomatic hydrothorax, refractory to diuretics and fluid and sodium restriction, and then an hepatorenal syndrome. Treatment consisted of chest tube insertion and 5 days' intravenous infusion of octreotide. Complete clinical and biological data were reviewed. octreotide administration resulted in an increased urinary outflow and sodium output, concomitant with improved renal function. The patient has been free of symptoms after discharge from hospital for a follow-up period of 5 months. This observation raises interesting issues regarding the possible utility of splanchnic vasoconstrictors, reducing portal hypertension, in the treatment of refractory hepatic hydrothorax.- - - - - - - - - - ranking = 1keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
2/6. Combined treatment of liver failure and hepatorenal syndrome with orthotopic liver transplantation.hepatorenal syndrome (HRS) is a severe complication of liver failure with high mortality. The pathogenesis of this reversible functional renal failure is not yet clearly understood. diagnosis is based upon the association of clinical and biological criteria. A patient was admitted to our institution for severe liver failure secondary to an exacerbation of cirrhosis, where he developed a fulminant hepatorenal syndrome. Both, the renal and hepatic failure were successfully treated by orthotopic liver transplantation. Special attention was paid to the immunosuppressive treatment with cyclosporine whose use, we believe, should be delayed until function has partially recovered.- - - - - - - - - - ranking = 5keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
3/6. calciphylaxis associated with acute, reversible renal failure in the setting of alcoholic cirrhosis.We describe a case of calciphylaxis in a 47-year-old man with alcohol-induced end-stage liver disease and acute renal failure secondary to hepatorenal syndrome. Possible contributing factors included transiently impaired renal function, protein c and S deficiencies, elevated calcium-phosphate product, hyperphosphatemia, low serum albumin, repeated albumin infusions, and elevated alkaline phosphatase level.- - - - - - - - - - ranking = 1keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
4/6. Alcoholic cirrhosis-associated hepatorenal syndrome treated with vasoactive agents.BACKGROUND: A 35-year-old man with alcoholic cirrhosis, ascites and alcoholic hepatitis presented with new-onset renal insufficiency of unclear etiology after recovery from an episode of gastrointestinal bleeding. Renal function continued to worsen after cessation of diuretic therapy and initiation of volume resuscitation. INVESTIGATIONS: physical examination, abdominal ultrasound, liver tests, basic metabolic panel, abdominal paracentesis, renal function tests, 24-h urine collections. diagnosis: Type 1 hepatorenal syndrome (HRS). MANAGEMENT: Intravascular volume resuscitation with normal saline and albumin followed by oral midodrine plus subcutaneous octreotide therapy. This regimen was continued until improvement and subsequent normalization of the serum creatinine.- - - - - - - - - - ranking = 5keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
5/6. hepatorenal syndrome complicating chronic lymphocytic leukemia.hepatorenal syndrome and portal hypertension developed in a 59-year-old man with chronic lymphocytic leukemia. At autopsy, he had portal hypertension from lymphocytic infiltration of the liver with compression of the portal veins, and no other pathologic process in the liver. Histologic examination of the kidney did not reveal a lesion that could account for the observed renal insufficiency. This case report documents the association of a lymphoproliferative disorder with portal hypertension and hepatorenal syndrome.- - - - - - - - - - ranking = 1keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |
6/6. Improvement of hepatorenal syndrome by transjugular intrahepatic portosystemic shunt.hepatorenal syndrome (HRS) is a functional renal failure occurring in advanced liver cirrhosis with ascites. It is due to renal cortical vasoconstriction resulting from complex hemodynamic disturbances related to cirrhosis and portal hypertension. There is no consistently effective therapy except for liver transplantation. We report a case of severe HRS in a patient with advanced liver cirrhosis and portal hypertension. Three sessions of hemodialysis were performed because of severe renal failure (serum urea 83 mg/dl, serum creatinine 6 mg/dl). Creation of an intrahepatic portosystemic shunt reduced the portocaval gradient from 18 to 7 mm Hg. Spectacular improvement of the renal function was observed soon after the procedure, with spontaneous recovery of diuresis and a return of serum urea and creatinine to baseline values. The patient unfortunately died 2 months later from adult respiratory distress syndrome post emergency surgery for a massive bleed related to a duodenal ulcer. Throughout this episode, the renal function remained stable. The postmortem examination showed histologically normal kidneys. We conclude that the intrahepatic portosystemic shunt can improve renal function in cirrhotic patients with HRS; it could be used in patients awaiting liver transplantation to reverse preoperative renal failure.- - - - - - - - - - ranking = 4keywords = hepatorenal syndrome, hepatorenal (Clic here for more details about this article) |