Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function.
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007594.
Dart AB, Mutter TC, Ruth CA, Taback SP.
Department of Pediatrics and Child Health, University of Manitoba, FE-009 840 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1S1.
BACKGROUND: Hydroxyethyl starches (HES) are synthetic colloids commonly used for fluid resuscitation, yet controversy exists about their impact on kidney function. OBJECTIVES: To examine the effects of HES on kidney function compared to other fluid resuscitation therapies in different patient populations. SEARCH STRATEGY: We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE, EMBASE, MetaRegister and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs in which HES was compared to an alternate fluid therapy for the prevention or treatment of effective intravascular volume depletion. Primary outcomes were renal replacement therapy (RRT), author-defined kidney failure and acute kidney injury (AKI) as defined by the RIFLE criteria. Secondary outcomes included serum creatinine and creatinine clearance.
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Severe sepsis in cirrhosis.
Hepatology. 2009 Dec;50(6):2022-33.
Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R.
Institut National de la Santé et de la Recherche Médicale, U773, Centre de Recherche Bichat-Beaujon CRB3, Paris 75018, France.
Sepsis is physiologically viewed as a proinflammatory and procoagulant response to invading pathogens. There are three recognized stages in the inflammatory response with progressively increased risk of end-organ failure and death: sepsis, severe sepsis, and septic shock. Patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. There is evidence that in cirrhosis, sepsis is accompanied by a markedly imbalanced cytokine response ("cytokine storm"), which converts responses that are normally beneficial for fighting infections into excessive, damaging inflammation. Molecular mechanisms for this excessive proinflammatory response are poorly understood. In patients with cirrhosis and severe sepsis, high production of proinflammatory cytokines seems to play a role in the worsening of liver function and the development of organ/system failures such as shock, renal failure, acute lung injury or acute respiratory distress syndrome, coagulopathy, or hepatic encephalopathy.
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