Article citationsMore>>

P. Sort, M. Navasa, V. Arroyo, X. Aldeguer, R. Planas, L. Ruiz-del-Arbol, L. Castells, V. Vargas, G. Soriano, M. Guevara, P. Ginès and J. Rodés, “Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis,” New England Journal of Medicine, Vol. 341, 1999, pp. 403-409. http://dx.doi.org/10.1056/NEJM199908053410603

has been cited by the following article:

• TITLE: Hepatorenal Syndrome

  AUTHORS: Tyree H. Kiser

  KEYWORDS: Hepatorenal Disorder; Cirrhosis; Portal Hypertension; Transplantation; Vasopressors

  JOURNAL NAME: International Journal of Clinical Medicine, Vol.5 No.3, January 24, 2014

  ABSTRACT: Hepatorenal syndrome (HRS) is the most serious hepatorenal disorder and one of the most difficult to treat. To date, the best treatment options are those that reverse the mechanisms underlying HRS: portal hypertension, splanchnic vasodilation, and/or renal vasoconstriction. Therefore, liver transplantation is the preferred definitive treatment option. The role of other therapies is predominantly to prolong survival sufficiently to allow patients to undergo transplantation. Terlipressin with the addition of adjunctive albumin volume expansion is the preferred pharmacologic therapy for the treatment of patients with HRS. Norepinephrine and vasopressin are acceptable alternatives in countries where terlipressin is not yet available. For patients with Type II HRS, midodrine plus octreotide appears to be an effective pharmacologic regimen that can be administered outside of an intensive care unit setting. Regardless of chosen vasoconstrictor therapy, careful monitoring is needed to ensure tissue ischemia and severe adverse effects do not occur. Artificial hepatic support devices, renal replacement therapy, and transjugular intrahepatic portosystemic shunt (TIPS) are non-pharmacologic options for patients with HRS. However, hepatic support devices and renal replacement therapies have not yet demonstrated improved outcomes and TIPS is difficult to be employed in patients with Type I HRS due to contraindications in the majority of patients. Despite advances in our understanding of hepatorenal syndrome, the disease is still associated with significant morbidity, mortality, and costs. More evidence is urgently needed to help improve patient outcomes in this difficult-to-treat population.