Hepatorenal syndrome albumin

Ortega R, Gines P, Uriz J, Cardenas A, Calahorra B, De Las Heras D, Guevara M, Bataller R, Jimenez W, Arroyo V, Rodes J. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome results of a prospective, nonrandomized study. Hepatology 2002 36(4 Pt l) 941-8. 

The next day the patient had decreased respiratory rate, became tired with falling blood sugar and acidosis. She had acute renal failure with urine output <30 mL/h and was in fluid overload. The doctors started her on terlipressin 2 mg q.d.s. and HAS (Human Albumin Solution) 20% to maintain central venous pressure 8-12 mmHg and prevent hepatorenal syndrome. Terlipressin is a prodrug for vasopressin. 

The diagnosis is initially based on the principal symptom of oliguria (urine volume < 500 tnl/day). When setting up a differential diagnosis, the classification of oliguria is facilitated by a probationary volume replenishment (1500 ml of 0.9% NaCl solution or 5% human albumin). A clear improvement in or normalization of urine excretion achieved in this way is evidence against hepatorenal syndrome and in favour of prerenal kidney failure, (s. tab. 17.4)... 

Duvoux, C., Zanditenas, D., Hezode, C., Chauvat, A., Monin, XL., Rou-dot-Thoraval, F., Mallat, A., Dhumeaux, D. Effects of noradrenalin and albumin in patients with type 1 hepatorenal syndrome a pilot study. Hepatology 2002 36 374-380... 

Fevery, X, van Cutsem, E., Nevens, F., van Steenbergen, W., Verberck-moes, R., de Groote, X Reversal of hepatorenal syndrome in four patients by peroral misoprostol (prostaglandin El analogue) and albumin administration. J. Hepatol. 1990 11 153-158... 

Mitzner, St.R., Stange, R., Klammt, S., Risler, T., Erley, C.M., Bader, B.D., Berger, E.D., Lauchart, W., Peszynski, P., Freytag, X, Hickstein, H., Loock, X, Lohr, X-M., Liebe, St., Emmerich, X, Korten, G., Schmidt, R. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS results of a prospective randomized, controlled clinical trial. Liver Transplant. 2000 6 277 — 286... 

Uriz, X, Gines, R, Cardenas, A., Sort, R, Jimenez, W., Salmeron, JJM., Bataller, R., Mas, A., Navasa, M., Arroyo, V., Rodes, J. Terhpressin plus albumin infusion an effective and safe therapy of hepatorenal syndrome. X. Hepatol. 2000 33 43-48... 

Albumin is used in combination with vasoconstrictor drugs, such as terlipressin and octreotide, in treating hepatorenal syndrome. Adverse events were reported in four trials, but it was not clear which drug had caused them [l , 2 ]. 

Nazar A, Pereira GH, Guevara M, Martin-Llahi M, Pepin MN, Marinelli M, Sola E, Baccaro ME, Terra C, Arroyo V, Gines P. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2010 51(1) 219-26. 

Cardiovascular In two meta-analyses the rates of adverse events in four randomized controlled trials of terlipressin in type 1 hepatorenal syndrome were 10% and 14% [88, 89 ]. The relative risk of ischemic events with terlipressin was 9 (95 % Cl=2,38). There was a similar prevalence of ischemia in another study of 38 patients with type 1 hepatorenal syndrome treated with a combination of albumin and terlipressin, in which four patients developed ischemic complications [90,33. ... 

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