Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 23 January 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Noradrenalin and albumin effectively treats type 1 hepatorenal syndrome

Type 1 hepatorenal syndrome can be safely and effectively treated using noradrenalin combined with albumin and furosemide finds a pilot study in the current issue of the journal Hepatology.

News image

fiogf49gjkf04

Scientists have known for almost half a century that hepatorenal syndrome (HRS) results from an intense active vasoconstriction of the renal arteries in an otherwise healthy kidney in the setting of advanced cirrhosis, or less commonly, acute liver failure.

The effect of this renal vasoconstriction is to dramatically reduce glomerular filtration rate (GFR), leading to renal failure.

However, because of the absence of any structural abnormalities in the kidneys of patients suffering HRS, physicians have always considered the disease to be theoretically reversible.

Despite this, all previous pharmacological and non-pharmacological therapies used to reverse HRS have proven unsuccessful, with liver transplantation being the only procedure known to improve renal function in such patients.

It is believed that renal vasoconstriction in HRS patients is the final consequence of an extreme vasodilation of the splanchnic arterial circulation.

This results in a reduction of the effective arterial blood volume (that is, the blood volume that is sensed by the central part of the arterial circulation) and an abnormal distribution of arterial blood volume.

This ultimately leads to a reduction in blood flow to all extra-splanchnic areas, including the kidneys.

A new therapeutic approach to reversing HRS has been the use of vasoconstrictors such as vasopressin analogues.

Administration of these drugs has been shown to greatly improve circulatory function in HRS, along with increased arterial pressure and a near-normalization of the activity of the major endogenous vasoconstrictor systems (renin-angiotensin system and sympathetic nervous system).

In addition, these effects are also associated with improved renal function, with marked increases in renal plasma flow, GFR, urine volume and serum sodium concentration in about two-thirds of patients treated.

A pilot study has now examined the efficacy and safety of noradrenalin (NA) in the treatment of type 1 HRS (the clinical form characterized by rapidly progressive renal failure).

Between 1998 and 2000, 12 consecutive patients with type 1 HRS (7 men, 5 women; mean age 54 years; mean Child-Pugh score 11.3) were given intravenous NA (0.5-3 mg/h), in combination with intravenous albumin and furosemide.

NA was administered for an average of 10 days, at a mean dose of 0.8 mg/h.

HRS reversal:
Occurred in 83% of noradrenalin-treated patients.
Hepatology

In 10 of the 12 patients (83%), reversal of HRS was observed after a median of 7 days (range 5-10 days).

Serum creatinine levels fell from 358 ± 161 to 145 ± 78 µmol/l, while creatinine clearance rose from 13 ± 9 to 40 ± 15 ml/min and urinary sodium output increased from 8 ± 14 to 52 ± 72 mEq/d.

The changes in renal function under NA treatment were associated with an increase in mean arterial pressure (MAP; 65 ± 7 to 73 ± 9 mm Hg).

A marked reduction in active renin (565 ± 989 to 164 ± 196 ng/l) and aldosterone plasma concentrations (1,945 ± 1,931 to 924 ± 730 ng/ml) was also observed.

There was one episode of reversible myocardial hypokinesia (in a patient on 1.5 mg/h NA) that did not recur after a dose reduction.

The research group that carried out the study concludes that "NA combined with albumin and furosemide appears effective and safe for the treatment of type 1 HRS."

However, writing in an accompanying editorial, Dr Pere Ginès and Dr Mónica Guevara caution that this study, along with previous studies using vasoconstrictors for HRS "raise important questions from a therapeutic and pathophysiologic perspective that need to be addressed in future studies."

Hepatology 2002; 36(2): 374-380
01 August 2002

Go to top of page Email this page Email this page to a colleague

 23 January 2018 
Atrophic gastritis after H. pylori eradication
 23 January 2018 
Ectopic pregnancy in women with IBD
 23 January 2018 
Celiac disease in IBS in the USA
 22 January 2018 
Improving symptoms in GERD
 22 January 2018 
Costs of biologic therapies for IBD in the USA
 22 January 2018 
Western vs Asian guidelines for colon cancer management
 19 January 2018 
Ileoanal pouch microbiota
 19 January 2018 
Predicting the risk of early surgery in Crohn’s
 19 January 2018 
Lifestyle intervention vs gastric bypass for obesity and diabetes
 18 January 2018 
Sleeve gastrectomy vs Roux-en-Y gastric bypass
 18 January 2018 
Healthcare costs of liver cancer in the USA
 18 January 2018 
High-risk adenomas at colonoscopy
 17 January 2018 
“Weekend effect” in upper GI hemorrhage
 17 January 2018 
Gut dysbiosis and non-antibiotic prescription medications
 17 January 2018 
Reducing surgical infections in high-outlier colorectal unit
 16 January 2018 
Bundle of care in GI cancer surgery
 16 January 2018 
Anxiety about colonoscopy
 16 January 2018 
Thiopurines and colorectal neoplasia in IBD
 15 January 2018 
Risks of death after liver transplants for liver cancer
 15 January 2018 
Recent advances in hepatocellular carcinoma
 15 January 2018 
Ileostomy output using telemedicine
 12 January 2018 
Surveillance protocols after colorectal cancer resection
 12 January 2018 
Biologic therapy by pregnant women with IBD and infant vaccines
 12 January 2018 
Biologic therapies for IBD in the USA
 11 January 2018 
Genetic risk factors in GERD
 11 January 2018 
Predictor of colorectal adenoma
 11 January 2018 
Ectopic pregnancy in IBD 
 10 January 2018 
Fecal immunochemical tests for colorectal cancer screening
 10 January 2018 
Risk factors for advanced NAFLD
 10 January 2018 
Dyspepsia prevalence with gastroesophageal reflux–type symptoms
 09 January 2018 
Screening intervals for people with family histories of colorectal cancer
 09 January 2018 
Financial impact of colorectal cancer
 09 January 2018 
Current practice and future research in autoimmune hepatitis
 08 January 2018 
Reliability of the IBD index
 08 January 2018 
Improving prognosis in patients with primary sclerosing cholangitis
 08 January 2018 
Aprepitant and nausea with gastroparesis
 05 January 2018 
Autoimmune pancreatitis and IBD
 05 January 2018 
Primary nonresponse to infliximab therapy
 05 January 2018 
Anesthesia assistance in outpatient colonoscopy
 04 January 2018 
Dietary polyphenols in the etiology of IBD
 04 January 2018 
Yoga vs low-FODMAP in IBS
 04 January 2018 
Local esophageal food allergen injections in eosinophilic esophagitis
 03 January 2018 
Critical research gaps in colorectal cancer
 03 January 2018 
Population health management for IBD
 03 January 2018 
GERD in asthma and COPD
 22 December 2017 
Costs of extrahepatic manifestations of Hep C
 22 December 2017 
Cholera vaccine and risk of death in colorectal cancer
 22 December 2017 
Colonoscopy after colorectal cancer resection
 21 December 2017 
Human oral microbiome and pancreatic cancer risk
 21 December 2017 
Health management for IBD
 21 December 2017 
PPI and Alzheimer's disease
 20 December 2017 
Management of abnormal liver blood tests
 20 December 2017 
Incidence of biopsy-verified celiac disease
 20 December 2017 
Osteoporotic fractures in Barrett's esophagus
 19 December 2017 
Alcohol abstinence and alcoholic hepatitis
 19 December 2017 
Family burden of pediatric Crohn's in the USA
 19 December 2017 
Early readmission in IBD patients
 18 December 2017 
Colorectal cancer mortality with low-risk adenomas at colonoscopy
 18 December 2017 
Disease activity indices in celiac disease
 18 December 2017 
Smoking behaviour predicted the risk of surgery in Crohn's

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us