Renal Function In Cirrhotic Patients Research Articles

OCTREOTIDE-INDUCED ASYSTOLE IN A 70-YEAR-OLD WOMAN

OCTREOTIDE-INDUCED ASYSTOLE IN A 70-YEAR-OLD WOMAN

S1322 Large Volume Paracentesis in Cirrhotic Patients With Acute Kidney Injury Is Not Associated With Worsening of Renal Function; Analysis of a Multi-Institutional Cohort

Introduction: Effect of large volume paracentesis on renal function in cirrhotic patients with ongoing acute kidney injury has not been studied in detail, and large volume paracentesis (LVP) is often avoided in these patients due to concerns of worsening renal injury. We studied the association between volume removed on paracentesis and outcomes of acute kidney injury. Methods: We performed a retrospective cohort study of patients at two institutions. IRB approval was obtained at both institutions. Patients with acute kidney injury at the time of paracentesis were included in the study. A retrospective chart review was then performed, and variables of interest were collected. Data was then de-identified and then pooled for analysis. Results: One-hundred and sixty-two patients were included in the final cohort. The mean age of study participants was 61.10 years (SD: ±11.70); the population was predominantly male (63.6%). Alcohol was the most common etiology (43%), followed by NASH (30%). One hundred and eleven patients had Child C cirrhosis (68.5%). Pre-renal acute kidney injury was the most common etiology prior to paracentesis (51%); eighty-six patients had KDIGO stage 1 acute kidney injury while 37 patients and 39 patients had Stage 2 and Stage 3 respectively. Forty-eight participants (29.6%) experienced a worsening of creatinine after paracentesis. Large volume paracentesis (4L or greater) was performed on 81 patients while the rest had less than 4L removed; the groups were well matched with no statistically significant difference in baseline characteristics. There was no difference in the proportion of patients experiencing worsening of renal function after paracentesis, in the proportion of patients who experienced eventual complete resolution of acute kidney injury (p-value = 0.55), or in the proportion of patients that requirement renal replacement therapy (p-value = 0.51). Multivariable regression analysis was conducted incorporating age, gender, CKD, MELD-Na score, albumin administration, and amount of volume removed during paracentesis, revealing CKD as the only covariate significantly associated with worsening renal function after paracentesis (p-value = 0.003). Large volume removal during paracentesis was not associated with worsening of renal function (p-value = 0.61). Conclusion: Large volume paracentesis is not associated with worsening renal function, when compared to small volume paracentesis, in cirrhotic patients with pre-existing acute kidney injury.

Role of Serum Cystatin C as a Diagnostic Tool for Renal Function in Cirrhotic Patients

Background: Assessment of cystatin C levels could be valuable in the early detection of renal dysfunction because they increase faster than the creatinine levels as the GFR decreases. The aim of this work was to evaluate serum cystatin C as a diagnostic tool for renal dysfunction in cirrhotic patients with and without hepatorenal syndrome (HRS). Methods: This case-control study was conducted on 60 patients from the Tropical Medicine Department of Tanta University Hospitals and 10 people served as healthy control volunteers. Serum cystatin C was measured in the three groups. Results: A significant difference was observed among the three groups as cystatin C was higher in patients with HRS compared to the cirrhotic group and healthy controls. Conclusion: Serum cystatin C is a good predictor for hepatorenal syndrome with a good correlation with serum creatinine, blood urea, GFR, and creatinine clearance.

Estimated glomerular filtration rate by formulas in patients with cirrhosis: An unreliable procedure.

In cirrhosis, the reliability of formulas that estimate renal function, either those specifically developed in this population or the classic equations, has not been properly quantified. We studied the agreement between estimated (eGFR) and measured glomerular filtration rate (mGFR) in cirrhosis. Renal function was estimated with 56 formulas including specific equations: Glomerular Filtration Rate Assessment in Liver Disease (GRAIL), Royal Free Hospital Cirrhosis (RFHC) and Mindikoglu-eGFR, and measured with a gold standard procedure; plasma clearance of iohexol using dried blood spots sampling in a group of cirrhotics. The agreement eGFR-mGFR was evaluated with specific tests: total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). We defined acceptable agreement as values: TDI<10%, CCC≥0.9 and CP>90%. A total of 146 patients (age 65±9years, 81% male) were evaluated; 61 (42%) Child A, 67 (46%) Child B and 18 (12%) Child C. Median MELD-Na was 14 (9-15). The agreement between eGFR and mGFR was poor: TDI averaged was of 73% (90% of the estimations ranged from ±73% of mGFR); CCC averaged was 0.7 indicating low concordance and CP averaged 22% indicating that 78% of the estimations have an error>10%. Specific formulas showed also poor agreement: TDI was 82%, 70% and 37% for the GRAIL, RFHC and Mindikoglu equations, respectively. Overall, formulas poorly estimated renal function in cirrhotic patients. Specific formulas designed for cirrhosis did not outperform classic equations. eGFR must be considered with caution in cirrhotic patients.

Functional magnetic resonance imaging-based assessment of terlipressin vs. octreotide on renal function in cirrhotic patients with acute variceal bleeding (CHESS1903): study protocol of a multicenter randomized controlled trial.

Acute variceal bleeding is one of the critical complications in patients with liver cirrhosis. Severe renal vasoconstriction in consequence of low peripheral vascular resistance triggers the reduction of glomerular filtration rate (GFR), and thus induces acute kidney injury (AKI)/hepato-renal syndrome (HRS). Terlipressin and octreotide have been used in the management of cirrhotic patients with variceal bleeding. Also, terlipressin has been recommended as the international first-line pharmacological therapy for the treatment of HRS. In addition, the use of renal functional magnetic resonance imaging (fMRI) has become increasingly prevalent in research and clinical applications. However, the renal function-protective effect of terlipressin and octreotide and the value of fMRI in monitoring renal function remains unclear in patients with cirrhosis undergoing acute variceal bleeding. This is a multicenter, randomized controlled trial (RCT). Participants will be 1:1 assigned randomly into either terlipressin or octreotide groups. Sixty participants with clinically and/or pathologically diagnosed cirrhosis and active gastroesophageal variceal bleeding (GVB) will be recruited in several sites in China. Participants will receive either the treatment of terlipressin or octreotide after assigned into each group. The primary end point for the trial is the renal function. The secondary end points are (I) renal perfusion; (II) renal blood oxygenation; (III) failure to control bleeding; (IV) intra-hospital rebleeding; (V) intra-hospital mortality; (VI) adverse events (AE); (VII) overall survival. Statistical analysis including multivariate Cox regression, Kaplan-Meier analysis with log-rank test, etc. will be conducted. The study will provide new insight into the protection of renal function in the process of the treatment of variceal bleeding in patients with cirrhosis. NCT04028323.

Functional MRI-based Assessment of Terlipressin vs. Octreotide on Renal Function in Cirrhotic Patients With Acute Variceal Bleeding (CHESS1903)

Functional MRI-based Assessment of Terlipressin vs. Octreotide on Renal Function in Cirrhotic Patients With Acute Variceal Bleeding (CHESS1903)

Serum creatinine in cirrhotic patients: a cornerstone

In arecent issue of Hepatology , Cullaro et al. highlighted, in apopulation of cirrhotic patients listed for liver transplant, the associationbetween patient’ s basal serum creatinine level, including “normal rangevalues” and the occurrence of acute kidney injury (AKI), the persistent kidneyinjury after AKI, and the death/delisting risk (1). In this retrospective singlecenter study involving 385 patients, they showed thanks to a competing riskanalysis, that each 1mg/dL increase of basal serum creatinine was associatedwith a 62 % higher risk of mortality. If these results confirm the crucialprognosis impact of an impaired renal function in cirrhotic patients, they alsoencourage us to stay alert to changes in creatinine values within the normalrange. This paper leads to key reflections on creatinine role in cirrhosismanagement.

Beyond serum creatinine: which tools to evaluate renal function in cirrhotic patients?

In cirrhotic patients, a high serum creatinine value is an independent mortality factor. Similarly, it is predictive of renal insufficiency after liver transplantation. In these cases, chronic kidney disease is also an independent mortality factor. A relevant evaluation of glomerular filtration rate is crucial, particularly in cases of end-stage liver disease or liver transplantation, and is key for the decision to undertake dual liver-kidney transplantation. Serum creatinine or creatinine-based equations are the most used tools in clinical practice but they significantly overestimate renal function. Equilibrium inulin renal clearance remains the gold standard but is time consuming and expensive. Cystatin C and cystatin C-based equations are less influenced by muscle mass or bilirubin value, but their dosage is not standardized and they are expensive. Pharmacological models using exogenous markers, new kidney biomarkers, Doppler coupled with ultrasounds, and kidney histology could be interesting tools but their indications need to be specified.

Simultaneous liver–kidney transplantation or liver transplantation alone for patients in need of liver transplantation with renal dysfunction

There have been no well defined guidelines to determine whether a kidney transplant should be offered to liver transplant candidates who have chronic kidney disease (CKD) or prolonged acute kidney injury while awaiting a liver transplant. This article provides a review of current literature on risk factors for CKD progression after liver transplantation alone (LTA) in patients with pretransplant renal dysfunction and the utility of cystatin C (Cyst C) to assess renal function in cirrhotic patients. Studies evaluating risk factors for transplant futility are also discussed. Based on available literature and existing consensus guidelines, a proposed algorithm for simultaneous liver-kidney transplantation (SLKT) or LTA is formulated. In LTA recipients with pretransplant renal dysfunction, diabetes mellitus and type 2 hepatorenal syndrome are associated with CKD progression posttransplant. Coexisting diabetes and stages 3-4 CKD increase end-stage renal disease risk. Cyst C may be a better marker of renal function in cirrhotics. In LTA recipients, very high MELD scores and the concomitant presence of multiple comorbidities increase liver transplant futility risk. Similar studies in SLKT recipients are lacking. Pretransplant diabetes status should be incorporated into future guidelines for SLKT, whereas simultaneous kidney transplantation should be deferred in highest acuity SLKT candidates with high kidney transplant futility risk. Cyst C-based equations may allow clinicians to better select the most appropriate candidates for SLKT or LTA. Further studies are needed.

The chronic kidney disease epidemiology collaboration equation combining creatinine and cystatin C accurately assesses renal function in patients with cirrhosis.

BackgroundAccurate measurement of renal function in cirrhotic patients is still challenging. To find the best test for the determination of the true glomerular filtration rate (GFR) in cirrhotic patients this study prospectively compared measured (m)GFR, the gold standard, with estimated (e)GFR using equations based on serum levels of creatinine and cystatin C.MethodsGFR was measured by sinistrin clearance using the bolus method in 50 patients with cirrhosis (Child Turcotte Pugh score A, B and C) and 24 age-matched healthy subjects as controls. Measured (m)GFR was compared to eGFR using bias, accuracy 10 % and 30 %, as well as correlation coefficients.ResultsCreatinine-based equations generally overestimated GFR in patients with cirrhosis and showed a bias (average difference between mGFR and eGFR) of −40 (CG), −12 (MDRD) and −9 (CKD-EPI-Cr) ml/min/1.73 m2. Cystatin C-based equations underestimated GFR, especially in patients with Child Turcotte Pugh score C (bias 17 ml/min/1.73 m2for CKD-EPI-CysC). Of these equations, the CKD-EPI equation that combines creatinine and cystatin C (CKD-EPI-Cr-CysC) showed a bias of 0.12 ml/min/1.73 m2 as compared to measured GFR.ConclusionsThe CKD-EPI equation that combines serum creatinine and cystatin C measurements shows the best performance for accurate estimation of GFR in cirrhosis, especially at advanced stages.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0188-0) contains supplementary material, which is available to authorized users.

A Curious Case of a Rapid Resolution of Acute Tubular Necrosis After Portal Vein Decompression in a Cirrhotic Patient With Underlying Hepatorenal Syndrome: A Case Report and Literature Review

Introduction: Acute kidney injury is a common complication in cirrhosis and is associated with a poor prognosis. Splanchnic vasodilatation triggered by portal hypertension with subsequent renal vasoconstriction appears to play a central role in the hemodynamic changes and the decline in renal function in cirrhotic patients. We report a case of a 54-year-old female with decompensated alcoholic cirrhosis and underlying type 2 hepatorenal syndrome (HRS) based on a low urine sodium and bland urinalysis, who presented with confusion and abdominal pain. Abdominal duplex ultrasound revealed acute non-occlusive portal and superior mesenteric vein thrombosis with increased portal pressure. The patient subsequently developed acute tubular necrosis (ATN) with a serum creatinine of 4.0 mg/dL from a baseline of 0.9 mg/dL. The diagnosis was made based on high urine sodium and the presence of urinary granular cast. Due to worsening renal function, hemodialysis was initiated. Mechanical thrombectomy of the superior mesenteric and portal vein thrombus was performed with a substantial decrease of portal pressure. Her renal function recovered significantly and returned to baseline 4 days after the procedures. In conclusion, a rise in portal pressure from extensive portal vein thrombosis in this case led to the profound renal hypoperfusion and worsening of HRS which led to ATN. Thus, decompression of portal hypertension and reversal of hemodynamics using TIPS and mechanical thrombectomy might have beneficial effects in other cirrhotic patients with similar presentation. Further studies are warranted to prove this theory.Figure 1Figure 2

Evaluation of renal function in patients with cirrhosis: Where are we now?

In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the "gold standard" to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.

The 24 Hour Urine Creatinine Clearance for Prediction of Glomerular Filtration Rate in Liver Cirrhosis Patients: Have We Considered All Elements?

Dear Editor, The correct estimation of renal function in patients with liver cirrhosis and chronic kidney disease (CKD) is difficult (1, 2). Direct measurement of glomerular filtration rate (GFR) using exogenous markers (iohexol or iothalamate) is considered the reference to assess renal function in cirrhotic patients (1, 2). However, direct measurement of GFR is not available at all transplant centers. The 24 hour urine creatinine clearance (CrCl) is widely used to measure GFR, and is calculated by multiplying the ratio of urine creatinine (Cr) to plasma Cr by 24 hours urine volume. However CrCl has several limitations. Besides the problem with accurately timed urine collection, CrCl is reported to overestimate the true GFR in liver cirrhosis patients compared with the direct measurement of GFR (1, 2). A low plasma Cr secondary to liver disease and poor muscle mass may overestimate GFR using CrCl. In addition, the GFR overestimation is also reported to be due to over-secretion of Cr from renal tubules in proportion to glomerular filtration, especially at low GFR (1, 2). Conversely, we have found that the total amount of Cr excreted in cirrhotic patients is lower than the minimum expected Cr excretion in 24 hours urine (20 mg/kg/day in males and 15 mg/kg/day in females). Hence, when urine Cr excretion is low, CrCl may also on the contrary underestimate the true GFR. In a retrospective study, we evaluated the charts of 160 consecutive patients who underwent liver transplantation alone (LTA) at our center from January 2002 to December 2012. Out of these, 25 patients had CKD with pre-transplant estimated GFR values ≤ 60 ml/min/ 1.73 m2 calculated using 4-variable and 6-variable modification of diet in renal disease (MDRD) equations. The 24-hour urine CrCl was available in all 25 patients within a month pre-transplant. Ten patients were excluded from analysis as their collected urine volumes were either 3000 ml suggesting under- or over- collection of urine. In remaining 15 patients, mean observed urine Cr excretion was significantly lower than the minimum expected Cr excretion in 24 hour urine (1.28 ± 0.62 grams/day vs. 1.69 ± 0.43 grams/day; P = 0.04). In these 15 patients with CKD, there was no significant difference between CrCl and MDRD-4 (49.6 ± 23.5 vs. 41.7 ± 11.6 respectively, P = 0.63), and between CrCl and MDRD-6 (49.6 ± 23.5 vs. 37.2 ± 9.5, respectively, P = 0.19) pre-transplant. However, GFR values at three months post-transplant were significantly higher compared with their corresponding values pre-transplant (see Table 1). The lower urine Cr excretion in these patients is probably secondary to decreased Cr production due to poor muscle mass and liver disease. The improvement in e-GFR early post-transplant suggests that there is likely some hemodynamic component to CKD pre-transplant. It is reported that the CKD eventually gets worse overtime post-LTA due to calcineurin inhibitor therapy and other risk factors (3, 4). In our study, although we did not measure GFR directly, the improved GFR values early post-LTA likely reflect true pre-transplant GFR values. In conclusion, although CrCl has been reported to overestimate GFR in liver cirrhosis patients with CKD, a lower than expected 24 hour urine creatinine excretion may also cause underestimation of GFR. Table 1. Pre- and Post-Liver Transplant (LT) e-GFR Values in 25 Study Patients

Sevoflurane has no adverse effects on renal function in cirrhotic patients: a comparison with propofol

Cirrhotic patients are prone to developing renal dysfunction after anaesthesia and surgery. However, no consensus has been reached whether sevoflurane could have adverse effects on renal function in cirrhotic patients. We hypothesised that the use of sevoflurane for general anaesthesia would lead to post-operative renal dysfunction in cirrhotic patients undergoing liver resection. A total of 200 patients undergoing liver resection were randomly assigned to a propofol or sevoflurane group. The influence of sevoflurane or propofol on renal function was evaluated by the maximal change, the difference between the pre-operative baseline and the highest values of serum creatinine and blood urea nitrogen measured at day 1, 3 and 6 post-operatively. The maximal change in serum creatinine after liver resection was -4.52 (5.78) μmol/l and -3.37 (7.34) μmol/l with P = 0.398, and that in blood urea nitrogen was 0.41 (1.49) mmol/l and 0.93 (1.54) mmol/l with P = 0.098 between the sevoflurane group (n = 52) and the propofol group (n = 50), respectively. Sevoflurane does not seem to impair post-operative renal function in cirrhotic patients undergoing liver resection.

The Effects of Terlipressin on Regional Hemodynamics and Kidney Function in Experimental Hyperdynamic Sepsis

Background and AimsAlthough terlipressin (TP) may improve renal function in cirrhotic patients, its use in sepsis remains controversial due to concerns about regional ischemia. We investigated the effects of TP on regional hemodynamics and kidney function in experimental hyperdynamic sepsis.MethodsWe studied thirteen merino ewes in a university physiology laboratory using a randomized controlled cross over design. We implanted flow probes around the pulmonary, circumflex coronary, superior mesenteric, renal and iliac arteries. We injected live Escherichia coli and induced hyperdynamic sepsis. We treated animals with either bolus vehicle or a single dose of TP (sTP = 1 mg). In a second group, after 1 mg of TP, two additional bolus injections (mTP) of 0.5 mg were given at 2 hourly intervals.Main ResultssTP (1 mg) significantly increased mean arterial pressure (MAP) (74 to 89 mmHg; P<0.0001) creatinine clearance (31 to 85 mL/min; P<0.0001) and urine output (24 to 307 mL/hr) (P<0.0001). However, it decreased CO (5.7 to 3.9 L/min; p<0.0001), coronary blood flow (CBF) (43 to 32 mL/min; p<0.0001) and mesenteric blood flow (MBF) (944 to 625 mL/min; p = 0.004) and increased blood lactate (2.1 to 4.0 mmol/L; p<0.0001). Extra doses of TP caused little additional effect.ConclusionsIn hyperdynamic sepsis, bolus TP transiently improves MAP and renal function, but reduces CO, CBF and MBF, and increases blood lactate. Caution should be applied when prescribing bolus TP in septic patients at risk of coronary or mesenteric ischemia.

Limitations of compensated Jaffe creatinine assays in cirrhotic patients

This study aimed to evaluate the impact of two creatinine measurement methods on the Model for End Stage Liver Disease (MELD) score and glomerular filtration rate estimation (eGFR) in cirrhotic patients. We focused on ID-MS traceable method such as compensated Jaffe (cJafCreat) and enzymatic (EnzCreat) methods. Potential protein-related interferences in creatinine determination were evaluated using dialysates spiked with albumin. MELD score, CKD-EPI formula creatinine-based eGFR and cystatin C-based eGFR were evaluated in 100 cirrhotic patients. In vitro model demonstrated that low protein levels result in an underestimation of creatinine levels using cJafCreat. In patients, cJafCreat created a negative bias of -6.1 μmol/L that led to higher eGFR and lower MELD scores. cJafCreat contributes to an overestimation of renal function in cirrhotic patients and may alter cirrhosis-severity assessment. Compensated Jaffe assays should therefore be replaced by enzymatic methods.

The efficacy and safety of terlipressin and albumin in patients with type 1 hepatorenal syndrome: a multicenter, open-label, explorative study

Treatment with terlipressin and albumin has been reported recently to be effective in improving renal function in the treatment of cirrhotic patients with hepatorenal syndrome (HRS). The aim of this prospective, multicenter study was to investigate the efficacy and safety of treatment with terlipressin and albumin in Japanese cirrhotic patients with type 1 HRS. Eight cirrhotic patients with type 1 HRS were included in the study. Terlipressin (2.8 ± 0.4 mg/day) and albumin (25.7 ± 2.8 g/day) were given simultaneously for 6.3 ± 4.2 days. Urine volume was significantly increased (p < 0.05) at the end of treatment compared with baseline. Serum creatinine levels were significantly decreased from 2.84 ± 0.45 to 1.08 ± 0.33 mg/dl (-61.9 ± 9.9%, p < 0.05) after terlipressin and albumin administration. Creatinine clearance was significantly increased (p < 0.05) after treatment. Plasma renin activity and norepinephrine were significantly decreased (p < 0.05) after therapy. Six of the 8 patients (75%) showed a complete response (reduction of serum creatinine to 1.5 mg/dl or less). The cumulative probabilities of survival at 4 and 12 weeks were 63 and 13%, respectively. Complication of congestive heart failure possibly related to this regimen was seen in 1 patient, but ischemic adverse events were not observed during the treatment. Treatment with terlipressin and albumin improves renal function in cirrhotic patients with type 1 HRS. However, the survival of cirrhotic patients with type 1 HRS remains poor, although it may be improved by this specific therapy.

Renal Function in Patients with Liver Cirrhosis

Background: Despite the poor prognosis of patients with both cirrhosis and renal failure, most reports on renal function and outcomes of cirrhosis have come from liver transplant registries. The present study aimed to investigate the association between renal function and cirrhosis in a broader population. Methods: 3,857 patients were enrolled after the exclusion of patients with incomplete data. The most recent demographic data after the latest laboratory measurements obtained at outpatient or inpatient department were collected. Results: In predicting renal function, estimated glomerular filtration rate (eGFR) was found to be dissociated from Child-Pugh points (β = –0.01, p = 0.691), different causes of cirrhosis, and presence of diabetes (β = –0.03, p = 0.112). In terms of predicting in-hospital mortality, the sensitivity (60–82%) and specificity (70–90%) of the model for end-stage liver disease (MELD) score increased with the decrease in eGFR. However, the blood urea nitrogen (BUN)/creatinine ratio was better than the MELD score in patients with normal eGFR. Conclusion: In contrast to prerenal causes of kidney injury, the underlying causes of cirrhosis or diabetes had relatively minor effects on renal function in cirrhotic patients. The BUN/creatinine ratio was a better index than the MELD score in predicting in-hospital mortality in cirrhotic patients with normal renal function.

S1923 Recurrence After Inguinal Hernia Repair in Patients With Liver Cirrhosis is Low and Unrelated to Child-Turcotte-Pugh Classification

A S L D A b st ra ct s According to common criteria, 11 patients were classified as type 1 HRS, 7 patients had type 2 HRS. After TIPS, HVPG was effectively reduced in all patients (before TIPS: 22,5 mmHg (SD 5,6); after TIPS 5,5 mmHg (SD 3,4)). No major procedure-related complication was observed. Renal function improved within hospital stay (serum creatinine 3.0 mg/dL (SD 2,7) to 1,9 mg/dL (SD 2,8)). Of all patients, 13 (72,2%) could be discharged from hospital with stable or improved renal function, one of them requiring continued hemodialysis; 5 Patients died (27,8%). Of patients with type 1 HRS, 6 (54,5%) were discharged from hospital whereas 5 (45,5%) died. Of patients with type 2 HRS, 6 (86%) survived, 1 patient (0,14%) died during hospital stay. CONCLUSION: In this retrospective study, transjugular intrahepatic portosystemic shunt has been shown to be able to improve renal function in cirrhotic patients with HRS and is associatited with comparatively low in-hospital mortality.

Renal Dysfunction Induced by Bacterial Infection other than Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: Incidence and Risk Factor

Background/AimsDeterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis (SBP) is a predictor for in-hospital mortality; however, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown. The aim of this study was to investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis.MethodsRetrospective data from inpatients with bacterial infections other than SBP were analyzed.ResultsEighty patients were recruited for the analysis. The types of infections included that of urinary tract (37.5%), pneumonia (23.8%), biliary tract (20%), cellulitis (12.5%), and bacteremia of unknown origin (6.3%). Renal dysfunction developed in 29 patients (36.3%), of which 11 patients had irreversible renal dysfunction. The initial MELD score, neutrophil count, albumin, and blood pressure were significant risk factors in the univariate analysis, whereas only the MELD score was an independent risk factor for the development of renal dysfunction (p<0.001) after multivariate analysis.ConclusionsThe prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 36.3%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients.