Hepatorenal syndrome – pathophysiology, diagnosis and treatment
Authors:
Vladimír Hrabovský; Alice Mendlová; Terezie Vavříčková
Authors‘ workplace:
Interní klinika LF OU a FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc.
Published in:
Vnitř Lék 2015; 61(7-8): 649-654
Category:
Reviews
Overview
Hepatorenal syndrome (HRS) is a life-treating complication of liver diseases. This functional kidney impairment is classified into acute (type I) and chronic (type II) types and is connected with high mortality. Treatment options are limited, but administration of vasoconstrictors (terlipressin), albumin and portosystemic shunt may improve their prognosis. Liver transplantation is the most effective method for these patients. Authors want to present recent data relating to HRS, including therapeutic recommendations.
Key words:
albumin – hepatorenal syndrome – liver cirrhosis – terlipressin
Sources
1. Salerno F, Cazzaniga M, Merli M et al. Diagnosis, treatment and survival of patients with hepatorenal syndrome: a survey on daily medical practice. J Hepatol 2011; 55(6): 1241–1248.
2. Devuni D, Anand BS, Ouyang A et al. Hepatorenal Syndrome. 2014. Dostupné z WWW: <http://emedicine.medscape.com/article/178208-overview>.
3. Hecker R, Sherlock S. Electrolyte and circulatory changes in terminal liver failure. The Lancet 1956; 268(6953): 1121–1125.
4. Arroyo V. Hecker R, Sherlock S. Electrolyte and circulatory changes in terminal liver failure [Lancet 1956;2: 1221–1225]. J Hepatol 2002; 36(3): 315–320.
5. Shear L, Kleinerman J, Gabuzda GJ. Renal failure in patients with cirrhosis of the liver. I. Clinical and pathologic characteristics. Am J Med 1965; 39: 184–198.
6. 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; 280(25): 1367–1371.
7. Iwatsuki S, Popovtzer MM, Corman JL et al. Recovery from “hepatorenal syndrome” after orthotopic liver transplantation. N Engl J Med 1973; 289(22): 1155–1159.
8. Barbano B, Sardo L, Gigante A et al. Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs. Curr Vasc Pharmacol 2014; 12(1): 125–135.
9. Guarner C, Soriano G, Such J et al. Systemic prostacyclin in cirrhotic patients. Relationship with portal hypertension and changes after intestinal decontamination. Gastroenterology 1992; 102(1): 303–309.
10. Wiest R, Shah V, Sessa WC et al. NO overproduction by eNOS precedes hyperdynamic splanchnic circulation in portal hypertensive rats. Am J Physiol 1999; 276(4 Pt 1): G1043-G1051.
11. García-Pagán JC, Fernández M, Bernadich C et al. Effects of continued NO inhibition on portal hypertensive syndrome after portal vein stenosis in rat. Am J Physiol 1994; 267(6 Pt 1): G984-G990.
12. Schrier RW, Arroyo V, Bernardi M et al. Peripheral arterial vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8(5): 1151–1157.
13. Hori N, Wiest R, Groszmann RJ. Enhanced release of nitric oxide in response to changes in flow and shear stress in the superior mesenteric arteries of portal hypertensive rats. Hepatology 1998; 28(6): 1467–1473.
14. Paper S. The role of the kidney in Laennec´s cirrhosis of the liver. Medicine (Baltimore) 1958; 37(4): 299–316.
15. Lieberman FL, Ito S, Reynolds TB. Effective plasma volume in cirrhosis with ascites. Evidence that a decreased value does not account for renal sodium retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR during drug-induced diuresis. J Clin Invest 1969; 48(6): 975–981.
16. Bernardi M, Fornale L, DiMarco C et al. Hyperdynamic circulation of advanced cirrhosis: a re-appraisal based on posture-induced changes in hemodynamics. J Hepatol 1995; 22(3): 309–318.
17. Bernardi M, Trevisani F, Fornale L et al. Renal sodium handling in cirrhosis with ascites: mechanisms of impaired natriuretic response to reclining. J Hepatol 1994; 21(6): 1116–1122.
18. Jalan R, Hayes PC. Sodium handling in patients with well compensated cirrhosis is dependent on the severity of liver disease and portal pressure. Gut 2000; 46(4): 527–533.
19. Jalan R, Forrest EH, Redhead DN et al. Reduction in renal blood flow following acute increase in the portal pressure: evidence for the existence of a hepatorenal reflex in man? Gut 1997; 40(5): 664–670.
20. Stanley AJ, Redhead DN, Bouchier IA et al. Acute effects of trans-jugular intrahepatis portosystemic stentshunt (TIPSS) procedure on renal blood flow and cardiopulmonary hemodynamics in cirrhosis. Amer J GE 1998; 93(12): 2463–2468.
21. Wong F. Cirrhotic cardiomyopathy. Hepatol Int 2009; 3(1): 294–304.
22. Salerno F, Gerbes A, Gines P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56(9): 1310–1318.
23. 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(2): 428–430.
24. 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(1): 258–266.
25. Claria J, Kent JD, Lopez-Parra M et al. Effects of celocoxib and naproxen on renal function in nonazotemic patients with cirrhosis and ascites. Hepatology 2005; 41(3): 579–587.
26. Guevara M, Fernandez-Esparrach G, Alessandria C et al. Effects of contrast media on renal function in patient with cirrhosis: a prospective study. Hepatology 2004; 40(3): 646–651.
27. Brůha R, Drastich P, Hůlek P et al. Doporučený postup pro diagnostiku a léčbu hepatorenálního syndromu. Vnitř Lék 2006; 52(6): 649–650.
28. 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. European Association for the Study of the Liver. J Hepatol 2010; 53(3): 397–417.
29. 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.
30. Fernández J, Navasa M, Planas R et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133(3): 818–824.
31. Gines A, Salmeron JM, Gines P et al. Oral misoprostol or intravenous prostaglandin E2 do not improve renal function in patients with cirrhosis and ascites with hyponatremia or renal failure. J Hepatol 1993; 17(2): 220–226.
32. Soper CP, Latif AB, Bending MR. Amelioration of hepatorenal syndrome with selective endothelin-A antagonist. Lancet 1996; 347 (9018): 1842–1843.
33. Schroeder ET, Anderson GH Jr, Smulyan H. Effects of a portacaval or peritoneovenous shunt on renin in the hepatorenal syndrome. Kidney Int 1979; 15(1): 54–61.
34. Lenz K, Hortnagl H, Druml W et al. Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis. Effects on renal hemodynamics and atrial natriuretic factor. Gastroenterology 1991; 101(4): 1060–1067.
35. Guevara M, Ginès P. Hepatorenal syndrome. Dig Dis 2005; 23(1):47–55.
36. Guevara M, Rodés J. Hepatorenal syndrome. Int J Biochem Cell Biol 2005; 37(1): 22–26.
37. Fabrizi F, Dixit V, Messa P et al. Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials. Int J Artif Organs 2009; 32(3): 133–140.
38. Narahara Y, Kanazawa H, Sakamoto C et al. The efficacy and safety of terlipressin and albumin in patients with type 1 hepatorenal syndrome: a multicenter, open-label, explorative study. J Gastroenterol 2011; 47(3): 313–320.
39. Gluud LL, Christensen K, Christensen E et al. Terlipresin for hepatorenal syndrome. Cochrane Database Syst Rev 2012; 9: CD005162. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD005162.pub3>.
40. Gluud LL, Christensen K, Christensen E et al. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 518ě9: 576–584.
41. Fabrizi F, Aghemo A, Messa P. Hepatorenal syndrome and novel advances in its management. Kidney Blood Press Res 2013; 37(6): 588–601.
42. Arroyo V, Fernandez J. Management of hepatorenal syndrome in patients with cirrhosis. Nat Rev Nephrol 2011; 7(9): 517–526.
43. Angeli P, Volpin R, Gerunda G et al. Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology 1999; 29(6): 1690–1697.
44. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2004; 40(1): 55–64.
45. Tavakkoli H, Yazdenpanah K, Mansourian M. Noradrenalin versus the combination of midodrine and octreotide in patients with hepatorenal syndrome: Randomized clinical trial. Int J Prev Med 2012; 3(11): 764–749.
46. Ghosh S, Choudhary N, Sharma K et al. Noradrenaline vs. terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study. Liver Intern 2013; 33(8): 1187–1193.
47. Brensing KA, Textor J, Strunk H et al. Transjugular intrahepatic portosystemic stent-shunt for hepatorenal syndrome. Lancet 1997; 349(9053): 697.
48. Brensing KA, Textor J, Perz J et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in bon-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut 2000; 47(2): 288–295.
49. Flora KD. Hepatorenal syndrome is reversible with medical therapy plus TIPS. J Watch Gastroenterol 2004. Dostupné z DOI: <http://dx.doi.org/10.1056/JG200410130000007>.
50. Testino G, Leone S, Ferro C et al. Severe acute alcoholic hepatitis and hepatorenal syndrome: role of transjugular intrahepatic portosystemic stent shunt. J Med Life 2012; 5(2): 203–205.
51. Gonwa T, Wadei H. The challenges of providing renal replacement therapy in decompensated liver cirrhosis. Blood Purif 2012; 33(1–3): 144–148.
52. Gonwa TA, Mai M, Melton L et al. Renal replacement therapy and orthotopic liver transplantation. The role of continuous veno-venous haemodialysis. Transplantation 2001; 71(10): 1424–1428.
53. Witzke O, Baumann M, Patschan D et al. Which patients benefit from haemodialysis therapy in hepatorenal syndrome? Gastroenterol Hepatol 2004; 19(12): 1369–1373.
54. Wong F, Raina N, Richardson R. Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment. Gut 2010, 59(3): 381–386.
55. Lavayssière L, Kallab S, Cardeau-Desangles I et al. Impact of molecular adsorbent recirculating system on renal recovery in type-1 hepatorenal syndrome patients with chronic liver failure. J Gastroenterol Hepatol 2013; 28(6): 1019–1024.
56. Goldaracena N, Marquez M, Selzner N et al. Living vs. deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case-control study. Am J Transplant 2014; 14(12): 2788–2795.
57. Ruiz R, Barri Y, Jennings L et al. Hepatorenal syndrome: a proposal for kidney after liver transplantation. Liver Transpl 2007; 13(6): 838–843.
58. Distant D, Gonwa TA. The kidney in liver transplantation. J Am Soc Nephrol 1993; 4(2): 129–136.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2015 Issue 7-8
Most read in this issue
- Ordinary disease – appendicitis
- Transcatheter aortic valve implantation – diagnostic, procedure and outcomes
- Hepatorenal syndrome – pathophysiology, diagnosis and treatment
-
Erectile dysfunction as the first sign of systemic vascular diseases and of organovascular arterial ischemic diseases.
Guidelines and Challenge of the Angiology section of Slovak Medical Chamber (AS SMC, 2015)