Hepatorenal syndrome in patients with acute alcoholic hepatitis

Czech version

Authors: P. Jarčuška ¹; Ľ. Beňa ²; A. Timková ¹; E. Veseliny ¹; M. Janičko ¹
Authors‘ workplace: I. interná klinika, LF UPJŠ a UN L. Pasteura Košice, Slovenská republika ¹; Transplantcentrum, UN L. Pasteura Košice, Slovenská republika ²
Published in: Gastroent Hepatol 2012; 66(2): 101-108
Category: Hepatology: Original Article

Overview

Hepatorenal syndrome is functional kidney failure in patients with portal hypertension and ascites.

Patients:
20 patients (13 men, 7 women) with acute alcoholic hepatitis and hepatorenal syndrome type 1 were hospitalised at the Intensive Care Unit, 1^st Dept. of Internal Medicine, University Hospital in Košice. All patients were treated with continual terlipressin infusion (1 mg daily, in case of low effect, dose increased to 2 mg daily) combined with albumin, mean treatment duration was 20.00 ± 11.69 days. Haemodialysis was indicated in 11 patients due to oligo-anuria with hyperhydratation, metabolic acidosis or hyperkalemia.

Results:
A complete response to therapy (creatinine < 133 µmol/l) was seen in 6 patients (30%), a response to treatment (> 20% creatinine decrease) was observed in 18 patients (90%). Therapy led to an increase in natrium, diuresis and natriuresis and a decrease in serum creatinine and the Child-Pugh score. Hospital mortality was 40%. No pre-treatment parameter except for the grade of hepatic encephalopathy (serum creatinine, bilirubin and natrium, natriuresis, diuresis and Child-Pugh score) was associated with mortality, but patients who survived showed an improvement in liver functions after therapy (Child-Pugh score and bilirubin decrease).

Conclusion:
Combined treatment with terlipressin and albumin improves renal functions in patients with acute alcoholic hepatitis and hepatorenal syndrome type 1, however, the survival of patients depends on an improvement in liver functions during the treatment.

Key words:
hepatorenal syndrome – acute alcoholic hepatitis – terlipressin – albumin – renal functions – mortality

Sources

1. Koppel MH, Coburn JW, Mims 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; 289(25): 1367–1371.

2. Henriksen JH. Cirrhosis: ascites and hepatorenal syndrome. Recent advances in pathogenesis. J Hepatol 1995; 23 (Suppl 1): 25–30.

3. Salerno F, Gerbes A, Ginès P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Postgrad Med J 2008; 84(998): 662–670.

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

5. Epstein M, Goligorsky MS. Endothelin and nitric oxide in hepatorenal syndrome: a balance reset. J Nephrol 1997; 10(3): 120–135.

6. Salerno F, Gerbes A, Ginès P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56(9): 1310–1318.

7. Lata J, Šenkyřík M. Hepatorenální syndrom. Interní Med pro Prax 2002; 4(1): 7–9.

8. Jarčuška P, Fraenkel E, Fehér J. Hepatorenalis szindróma. Orv Hetil 2005; 146(40): 2073–2081.

9. Ginès A, Escorell A, Ginès P et al. Incidence, predictive factors and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993; 105(1): 229–236.

10. Akriviadis E, Botla R, Briggs W et al. Pentoxyfylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology 2000; 119(6): 1637–1648.

11. De BK, Gangopadhyay S, Dutta D et al. Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial. World J Gastroenterol 2009; 15(13): 1613–1619.

12. 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(6): 403–409.

13. European Association for the Study of the Liver. EASL clinical practical guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53(3): 397–417.

14. Ortega R, Ginès P, Uriz J et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of prospective, nonrandomized study. Hepatology 2002; 36(4): 941–948.

15. Pereira G, Guevara M, Gines P. Management of hepatorenal syndrome. In: Gines P, Forns X, Abraldes JG et al (eds). Therapy in Liver Diseases. Barcelona: Elsevier Doyma 2010: 227–234.

16. Gluud LL, Christensen K, Christensen E et al. Systematic review of randomised trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51(2): 576–584.

17. McIntyre CW, Fluck RJ, Freeman JG et al. Characterization of treatment dose delivered by albumin dialysis in the treatment of acute renal failure associated with severe hepatic dysfunction. Clin Nephrol 2002; 58(5): 376–383.

18. Mitzner SR, Klammt S, Peszynski P et al. Improvement of multiple organ functions in hepatorenal syndrome during albumin dialysis with the molecular adsorbent recirculating system. Ther Apher 2001; 5(5): 417–422.

19. Jalan R, Sen S, Steiner C et al. Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol 2003; 38(1): 24–31.

20. Lafayette RA, Paré G, Schmid CH et al. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation. Clin Nephrol 1997; 48(3): 159–164.

21. Restuccia T, Ortega R, Guevara M et al. Effect of treatment of hepatorenal syndrome before transplantation on post transplantation outcome. A case-control study. J Hepatol 2004; 40(1): 140–146.