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Marta Cavallin, Salvatore Piano, Antonietta Romano, Silvano Fasolato, Anna Chiara Frigo, Gianpiero Benetti, Elisabetta Gola, Filippo Morando, Marialuisa Stanco, Silvia Rosi, Antonietta Sticca, Umberto Cillo, Paolo Angeli
UNLABELLED: In patients with cirrhosis and hepatorenal syndrome (HRS), terlipressin has been used either as continuous intravenous infusion or as intravenous boluses. To date, these two approaches have never been compared. The goal of this study was to compare the administration of terlipressin as continuous intravenous infusion versus intravenous boluses in the treatment of type 1 HRS. Seventy-eight patients were randomly assigned to receive either continuous intravenous infusion (TERLI-INF group) at the initial dose of 2 mg/day or intravenous boluses of terlipressin (TERLI-BOL group) at the initial dose of 0...
March 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Mattias Mandorfer, Simona Bota, Philipp Schwabl, Theresa Bucsics, Nikolaus Pfisterer, Matthias Kruzik, Michael Hagmann, Alexander Blacky, Arnulf Ferlitsch, Wolfgang Sieghart, Michael Trauner, Markus Peck-Radosavljevic, Thomas Reiberger
BACKGROUND & AIMS: Nonselective β blockers (NSBBs) reduce portal pressure and the risk for variceal hemorrhage in patients with cirrhosis. However, development of spontaneous bacterial peritonitis (SBP) in these patients could preclude treatment with NSBBs because of their effects on the circulatory reserve. We investigated the effects of NSBBs in patients with cirrhosis and ascites with and without SBP. METHODS: We performed a retrospective analysis of data from 607 consecutive patients with cirrhosis who had their first paracentesis at the Medical University of Vienna from 2006 through 2011...
June 2014: Gastroenterology
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice...
November 6, 2015: World Journal of Nephrology
Marta Cavallin, Patrick S Kamath, Manuela Merli, Silvano Fasolato, Pierluigi Toniutto, Francesco Salerno, Mauro Bernardi, Roberto Giulio Romanelli, Cosimo Colletta, Freddy Salinas, Antonio Di Giacomo, Lorenzo Ridola, Ezio Fornasiere, Paolo Caraceni, Filippo Morando, Salvatore Piano, Angelo Gatta, Paolo Angeli
UNLABELLED: Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial...
August 2015: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Florence Wong
Hepatorenal syndrome (HRS) is a serious complication of advanced cirrhosis with ascites. HRS develops as a result of abnormal haemodynamics, leading to splanchnic and systemic vasodilatation, but renal vasoconstriction. Increased bacterial translocation, various cytokines and mesenteric angiogenesis also contribute to splanchnic vasodilatation, and altered renal autoregulation is involved in the renal vasoconstriction. Type 1 HRS is usually initiated by a precipitating event associated with an exaggerated systemic inflammatory response that perturbs haemodynamics, resulting in multiorgan failure...
May 22, 2012: Nature Reviews. Gastroenterology & Hepatology
Ezequiel Rodríguez, Chiara Elia, Elsa Solà, Rogelio Barreto, Isabel Graupera, Alida Andrealli, Gustavo Pereira, Maria Poca, Jordi Sánchez, Mónica Guevara, Germán Soriano, Carlo Alessandria, Javier Fernández, Vicente Arroyo, Pere Ginès
BACKGROUND & AIMS: Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy...
May 2014: Journal of Hepatology
Paolo Angeli, Pere Gines
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis that is associated with poor survival. A rapid diagnosis of HRS and a prompt initiation of the treatment with terlipressin and albumin are mandatory because this leads to an improvement of prognosis. This review covers the predictive value of HRS on 3-month mortality beyond the MELD score and its consequential impact on the prioritization policy to liver transplantation (LT). Moreover, it analyzes the impact of the response to pharmacological treatment on the MELD score, its possible delaying effect on the timing of LT, and suggests a way of overcoming the paradoxical effect of terlipressin and albumin on the priority to LT in responders...
November 2012: Journal of Hepatology
Virendra Singh, Souvik Ghosh, Baljinder Singh, Pradeep Kumar, Navneet Sharma, Ashish Bhalla, A K Sharma, N S Choudhary, Yogesh Chawla, C K Nain
BACKGROUND & AIMS: Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS. METHODS: Forty-six patients with HRS type 1 were managed with terlipressin (group A, N=23) or noradrenaline (Group B, N=23) with albumin in a randomized controlled trial at a tertiary center...
June 2012: Journal of Hepatology
Andrew Davenport, Jawad Ahmad, Ali Al-Khafaji, John A Kellum, Yuri S Genyk, Mitra K Nadim
Hepatorenal syndrome (HRS) is defined as the occurrence of renal dysfunction in a patient with end-stage liver cirrhosis in the absence of another identifiable cause of renal failure. The prognosis of HRS remains poor, with a median survival without liver transplantation of <6 months. However, understanding the pathogenesis of HRS has led to the introduction of treatments designed to increase renal perfusion and mean arterial blood pressure using vasopressors and albumin, which has led to improvement in renal function in ∼50% of patients...
January 2012: Nephrology, Dialysis, Transplantation
Michael Schepke
No abstract text is available yet for this article.
September 2007: Nephrology, Dialysis, Transplantation
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