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New treatments of hepatorenal syndrome. |
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New treatments of hepatorenal syndrome.
Semin Liver Dis. 2006 Aug;26(3):254-64.
Arroyo V, Terra C, Gines P.
Liver Unit, Institut of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain.
Hepatorenal
syndrome (HRS) is a common complication of advanced cirrhosis,
characterized by renal failure and major abnormalities in the systemic
circulatory function. Renal failure is caused by intense
vasoconstriction of the renal circulation. The syndrome is probably the
final consequence of an extreme underfilling of the arterial
circulation, secondary to vasodilatation in the splanchninc vascular
bed and a decrease in cardiac output due to central hypovolemia. The
diagnosis of HRS is based on the exclusion of other causes of renal
failure.
The survival of patients with HRS is very short, particularly
when there is rapidly progressive renal failure (type-1 HRS). Liver
transplantation is the best therapeutic option but its applicability is
low. During the past few years effective treatment for HRS, such as
vasoconstrictor drugs (vasopressin analogues, proportional
variant-adrenergic agonists) associated with intravenous albumin
infusion and transjugular intrahepatic portosystemic shunts (TIPS),
have been introduced. They improve circulatory function, normalize
serum creatinine, and may improve survival. Sequential treatment with
vasoconstrictors plus albumin and TIPS is an attractive therapeutic
possibility. Plasma volume expansion with albumin at infection
diagnosis in patients with spontaneous bacterial peritonitis and the
administration of pentoxiphilline in patients with severe alcoholic
hepatitis significantly reduce the development of type-1 HRS.
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