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Type 1 HRS (type 1 + hr)

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Medical Sciences	100%

Selected Abstracts

Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome,

HEPATOLOGY, Issue 1 2010
André Nazar
Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy. The aim of this study was to assess predictive factors of response to treatment with terlipressin and albumin in patients with type 1 HRS. Thirty-nine patients with cirrhosis and type 1 HRS were treated prospectively with terlipressin and albumin. Demographic, clinical, and laboratory variables obtained before the initiation of treatment as well as changes in arterial pressure during treatment were analyzed for their predictive value. Response to therapy (reduction in serum creatinine <1.5 mg/dL at the end of treatment) was observed in 18 patients (46%) and was associated with an improvement in circulatory function. Independent predictive factors of response to therapy were baseline serum bilirubin and an increase in mean arterial pressure of ,5 mm Hg at day 3 of treatment. The cutoff level of serum bilirubin that best predicted response to treatment was 10 mg/dL (area under the receiver operating characteristic curve, 0.77; P < 0.0001; sensitivity, 89%; specificity, 61%). Response rates in patients with serum bilirubin <10 mg/dL or ,10 mg/dL were 67% and 13%, respectively (P = 0.001). Corresponding values in patients with an increase in mean arterial pressure ,5 mm Hg or <5 mm Hg at day 3 were 73% and 36%, respectively (P = 0.037). Conclusion: Serum bilirubin and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. Alternative treatment strategies to terlipressin and albumin should be investigated for patients with type 1 HRS and low likelihood of response to vasoconstrictor therapy. (HEPATOLOGY 2009.) [source]

Acute renal failure in patients with cirrhosis: Perspectives in the age of MELD

HEPATOLOGY, Issue 2 2003
Richard Moreau
In patients with cirrhosis, acute renal failure is mainly due to prerenal failure (caused by renal hypoperfusion) and tubular necrosis. The main causes of prerenal failure are "true hypovolemia" (induced by hemorrhage or gastrointestinal or renal fluid losses), sepsis, or type 1 hepatorenal syndrome (HRS). The frequency of prerenal failure due to the administration of nonsteroidal anti-inflammatory drugs or intravascular radiocontrast agents is unknown. Prerenal failure is rapidly reversible after restoration of renal blood flow. Treatment is directed to the cause of hypoperfusion, and fluid replacement is used to treat most cases of "non-HRS" prerenal failure. In patients with type 1 HRS with very low short-term survival rate, liver transplantation is the ideal treatment. Systemic vasoconstrictor therapy (with terlipressin, noradrenaline, or midodrine [combined with octreotide]) may improve renal function in patients with type 1 HRS waiting for liver transplantation. MARS (for molecular adsorbent recirculating system) and the transjugular intrahepatic portosystemic shunt may also improve renal function in these patients. In patients with cirrhosis, acute tubular necrosis is mainly due to an ischemic insult to the renal tubules. The most common condition leading to ischemic acute tubular necrosis is severe and sustained prerenal failure. Little is known about the natural course and treatment (i.e., renal replacement therapy) of cirrhosis-associated acute tubular necrosis. [source]

Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: Results of a prospective, nonrandomized study

HEPATOLOGY, Issue 4 2002
Rolando Ortega
Vasopressin analogues associated with albumin improve renal function in hepatorenal syndrome (HRS). The current study was aimed at assessing the efficacy of the treatment, predictive factors of response, recurrence of HRS, and survival after therapy. Twenty-one consecutive patients with HRS (16 with type 1 HRS, 5 with type 2 HRS) received terlipressin (0.5-2 mg/4 hours intravenously) until complete response was achieved (serum creatinine level < 1.5 mg/dL) or for 15 days; 13 patients received intravenous albumin together with terlipressin. Twelve of the 21 patients (57%) showed complete response. Albumin administration was the only predictive factor of complete response (77% in patients receiving terlipressin and albumin vs. 25% in those receiving terlipressin alone, P = .03). Treatment with terlipressin and albumin was associated with a remarkable decrease in serum creatinine level, increase in arterial pressure, and suppression of the renin-aldosterone system. By contrast, no significant changes in these parameters were found in patients treated with terlipressin alone. Only 1 patient showed ischemic adverse effects. Recurrence of HRS occurred in 17% of patients with complete response. The occurrence of complete response was associated with an improved survival. In conclusion, terlipressin therapy reverses HRS in a high proportion of patients. Recurrence rate after treatment withdrawal is uncommon. Albumin appears to improve markedly the beneficial effects of terlipressin. [source]

Prognosis of hepatorenal syndrome , has it changed with current practice?

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2004
P. Angeli
Summary The Consensus Conference on Hepatorenal Syndrome (HRS) organized by the International Ascites Club in 1994 redefined HRS, introduced new diagnostic criteria that are now widely accepted, and proposed the distinction between two types of HRS: type 1 and type 2. Before the introduction of the new therapeutic options, the median survival of patients with type 1 HRS was only 1.7 weeks, and 6,12 months in patients with type 2 HRS. Liver transplantation (LT) was the first therapeutic option to change the prognosis of cirrhotic patients with HRS and 5-year survival after LT in patients with HRS is only slightly less than that of transplanted patients without HRS and markedly increased when compared to survival in nontransplanted patients with HRS. Nevertheless, a large proportion of patients die before LT is possible because of the poor prognosis of HRS and the prolonged waiting times in most transplant centres. Other therapeutic approaches were therefore developed to increase survival in patients with HRS. Vasoconstrictors and transjugular intrahepatic portosystemic shunt (TIPS) are the most promising. The administration of vasoconstrictors together with albumin has been shown to reverse type 1 HRS and even to completely normalize renal function in 60,70% of treated patients. To date, four studies assessing TIPS in the management of type 1 HRS have been reported and TIPS insertion was technically successful in all of them. Given the shortage of donors for LT, vasoconstrictor therapy and TIPS strategies may be considered as a bridge to LT in patients with type 1 HRS. [source]