HEPATORENAL SYNDROME: DIAGNOSTIC AND THERAPEUTIC MANAGEMENT

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Abstract

The practical guidelines on diagnosis and management of hepatorenal syndrome, which could be useful for general medical practitioners, gastroenterologists, and hepatologists, are considered in this paper. Selected recommendations are based on integrated clinical data, international recommendations and results of clinical trials. Beginning from theoretical grounds of hepatorenal syndrome (its definition, diagnostic criteria, and classification), acute kidney injury, and spontaneous bacterial peritonitis, the paper contains diagnostic algorithms (in particular, in ascites, for early revealing hepatorenal syndrome), and main approaches to therapy and prevention. The efficacy criteria and monitoring rules for the terlipressin-based therapy are listed.

About the authors

I. G. Bakulin

Moscow Clinical Scientific Center, Moscow Health Care Department; 86 Shosse Entuziastov, Moscow, 111123, Russian Federation
Medical Institute of Postgraduate Education, Moscow State University of Food Production; 11 Volokolamskoe sh., Moscow, 125080, Russian Federation

Author for correspondence.
Email: igbakulin@yandex.ru

д-р мед. наук, профессор, зав. отделом гепатологии ГБУЗ МКНЦ ДЗМ, зав. кафедрой гастроэнтерологии МИУВ ФГБОУ ВПО «МГУПП»

Россия

A. A. Varlamicheva

Moscow Clinical Scientific Center, Moscow Health Care Department; 86 Shosse Entuziastov, Moscow, 111123, Russian Federation

Email: fake@neicon.ru
мл. науч. сотр. отдела гепатологии ГБУЗ МКНЦ ДЗМ Россия

References

  1. 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. J Hepatol. 2010;53(3):397-417.
  2. Runyon BA; Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Management of adult patients with ascites due to cirrhosis. Hepatology. 2004;39(3):841-56.
  3. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, Vargas V, Soriano G, Guevara M, Ginès P, Rodés J. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403-9.
  4. Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48(6):2064-77.
  5. Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310-8.
  6. Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A, Alberino F, Gatta A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med. 1994;154(2):201-5.
  7. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.
  8. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23(1):164-76.
  9. Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361(13):1279-90.
  10. Kew MC, Varma RR, Sampson DJ, Sherlock S. The effect of octapressin on renal and intrarenal blood flow in cirrhosis of the liver. Gut. 1972;13(4):293-6.
  11. Lenz K, Hörtnagl H, Druml W, Reither H, Schmid R, Schneeweiss B, Laggner A, Grimm G, Gerbes 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):1060-7.
  12. Guevara M, Ginès P, Fernández-Esparrach G, Sort P, Salmerón JM, Jiménez W, Arroyo V, Rodés J. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology. 1998;27(1):35-41.
  13. Gülberg V, Bilzer M, Gerbes AL. Long-term therapy and retreatment of hepatorenal syndrome type 1 with ornipressin and dopamine. Hepatology. 1999;30(4):870-5.
  14. Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichaï P, Abergel A, Halimi C, Pauwels M, Bronowicki JP, Giostra E, Fleurot C, Gurnot D, Nouel O, Renard P, Rivoal M, Blanc P, Coumaros D, Ducloux S, Levy S, Pariente A, Perarnau JM, Roche J, Scribe-Outtas M, Valla D, Bernard B, Samuel D, Butel J, Hadengue A, Platek A, Lebrec D, Cadranel JF. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122(4):923-30.
  15. Fabrizi F, Dixit V, Martin P. Meta-analysis: terlipressin therapy for the hepatorenal syndrome. Aliment Pharmacol Ther. 2006;24(6):935-44.
  16. Gluud LL, Kjaer MS, Christensen E. Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev. 2006;(4):CD005162.
  17. Sanyal AJ, Boyer T, Garcia-Tsao G, Regenstein F, Rossaro L, Appenrodt B, Blei A, Gülberg V, Sigal S, Teuber P; Terlipressin Study Group. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008;134(5):1360-8.
  18. Martín-Llahí M, Pépin MN, Guevara M, Díaz F, Torre A, Monescillo A, Soriano G, Terra C, Fábrega E, Arroyo V, Rodés J, Ginès P; TAHRS Investigators. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008;134(5):1352-9.
  19. Moreau R, Lebrec D. The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond. Hepatology. 2006;43(3):385-94.
  20. Hiremath SB, Srinivas LD. Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: a meta-analysis. Indian J Pharmacol. 2013;45(1):54-60.
  21. Gines P, Arroyo V, Rodes J, Schrier R, editors. Ascites and renal dysfunction in liver disease. 2nd ed. Oxford: Blackwell Publishing; 2005.
  22. Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41(6):1282-9.
  23. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91-6.
  24. Boyer TD, Sanyal AJ, Garcia-Tsao G, Blei A, Carl D, Bexon AS, Teuber P; Terlipressin Study Group. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol. 2011;55(2): 315-21.
  25. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119(6):1637-48.

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Copyright (c) 2014 Bakulin I.G., Varlamicheva A.A.

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