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Renal failure in liver disease.
1Department of Nephrology and Medical Intensive Care, Charité, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany. eckardt@charite.de
Intensive Care Medicine
|March 2, 1999
Summary
Renal failure in liver disease is common and linked to poor outcomes. Prevention focuses on avoiding kidney damage, while treatments like plasma expansion and future therapies aim to improve kidney function.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Progressive renal failure is a significant adverse prognostic factor in cirrhosis and fulminant liver disease.
- Renal hypoperfusion, due to reduced perfusion pressure or increased vascular resistance, is a key mechanism in various forms of kidney injury, including hepatorenal syndrome and acute tubular necrosis.
Purpose of the Study:
- To review the pathophysiology and management strategies for renal failure in patients with liver disease.
- To highlight preventive measures and discuss current and emerging therapeutic options.
Main Methods:
- Review of existing literature on renal dysfunction in liver disease.
- Discussion of pathomechanisms, including renal hypoperfusion.
- Evaluation of current and potential future treatments.
Main Results:
- Prevention involves awareness of risks, avoiding nephrotoxins, and maintaining circulating volume.
- Plasma volume expansion is crucial for reversing early renal impairment.
- Pharmacological interventions targeting renal hemodynamics have had limited success, but new therapies targeting mediators like endothelin are promising.
Conclusions:
- Management of renal failure in liver disease requires a multi-faceted approach, including prevention, volume management, and consideration of novel therapies.
- Transjugular intrahepatic portosystemic shunt (TIPS) and renal replacement therapy (RRT), particularly continuous procedures, are valuable tools requiring further evaluation and application.