Renal and circulatory dysfunction in liver cirrhosis. Pathogenesis and treatment

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Annals of Gastroenterology
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Renal and circulatory dysfunction in liver cirrhosis. Pathogenesis and treatment (EN)

Arroyo V.,
Cardenas A.,

SUMMARY The clinical course of patients with cirrhosis is complicated by several disorders independent of the cause of the underlying liver disease. These include portal hypertension with development of esophageal varices, ascites and spontaneous bacterial peritonitis, hepatorenal syndrome (HRS) and hepatocellular carcinoma. Among these complications the development of renal dysfunction and hepatorenal syndrome are associated with a very poor prognosis. During the course of cirrhosis a derangement in renal function leads to an inability to maintain the extracellular fluid volume of the body within normal limits. This abnormal extracellular fluid volume regulation is associated with alterations in the splanchnic and systemic circulation as well as functional renal abnormalities that favor sodium and water retention. For the most part, the predominant renal function abnormality is sodium retention and its main clinical consequence is the recurrent accumulation of extracellular fluid as ascites and edema. In late stage cirrhosis, as renal function becomes more impaired, the kidney is unable to handle water properly and in addition the renal vasculature becomes severely vasoconstricted. The main clinical consequences of these two latter abnormalities are dilutional hyponatremia and hepatorenal syndrome (HRS), respectively. HRS is therefore a functional renal failure. In fact, renal function returns to normal after patients with HRS receive a liver transplantation. However, it should noted that some patients with cirrhosis due to hepatitis B or C are at risk of developing organic renal failure secondary to cryoglobulinemia or glomerulonephritis and these conditions should be excluded prior to making the diagnosis of HRS. (EN)


Αγγλική γλώσσα


Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 14, No 3 (2001) (EN)

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