Medical Treatment of Hepatorenal Syndrome - AASLD

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Common Pathogenesis in RefractoryAscites, Hyponatremia, and HRSCirrhosisIntrahepatic resistancePortal (sinusoidal) hypertensionSplanchnic/systemic vasodilatationEffective arterial blood volumeActivation <strong>of</strong> neurohumoral systemsSodiumretentionWaterretentionRenalvasoconstrictionAscitesRefractoryascitesHyponatremiaHRS
7060504030252015105Neurohumoral Systems AreMaximally Activated in HRSPlasma renin activity(ng/mL-h)80070060050040030025020015010050Plasma aldosterone activity(ng/dL)0HealthyCirrhosis Cirrhosis with asciteswithout without withascites renal renalfailure failure0Healthy CirrhosiswithoutascitesCirrhosis with asciteswithout withrenal renalfailure failureGines A, et al. Gastroenterology. 1993;105:229–236.
Page 1 and 2: Thomas D. Boyer, MDHepatorenal Synd
Page 3 and 4: Conflicts of interest• Member adv
Page 5: Pathogenesis of Ascites in Cirrhosi
Page 9 and 10: Type and Frequency of Injury inAcut
Page 11: Workup of Renal Dysfunction in Pati
Page 14 and 15: Hepatorenal syndromeAdditional Crit
Page 16 and 17: Type 1 HRS Is Associated WithVery P
Page 18 and 19: Who Develops HRS?•Cirrhotic patie
Page 20 and 21: Prevention of HRS
Page 22 and 23: Antibiotic Prophylaxis in VaricealB
Page 24 and 25: Prostaglandin Inhibition andEffects
Page 26 and 27: Treatment of HRS General• Stop al
Page 28 and 29: Site of Action of CurrentTherapies
Page 30 and 31: TIPS and HRSGut 47:166; 2000
Page 32 and 33: Treatment of HRS:Pharmacologic Ther
Page 34 and 35: Background (II)• Synthetic 12-ami
Page 36 and 37: Reversal of HRS40HRS Reversal (%)30
Page 38 and 39: Survival DistributionFunction1.00.9
Page 40 and 41: Adverse EventsTerlipressinN=56Place
Page 42 and 43: Impact of OLTx on RenalGlomerular f
Page 44 and 45: HRS conclusions continued• Exclus

Medical Treatment of Hepatorenal Syndrome - AASLD

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