Insufficient hepatic O2 in animal and human studies has been shown to elicit a hepatorenal reflex in response to increased hepatic adenosine, resulting in the stimulation of renal as well as muscle sympathetic nerve activity and activating the renin angiotensin system. Low hepatic ATP, hyperuricemia, and hepatic lipid accumulation reported in metabolic syndrome (MetS) patients may reflect insuf...

The endothelins are a group of three related peptides with two receptor subtypes, ET(A) and ET(B). Following the discovery of endothelin 1 as a potent vasoconstrictor, there has been intense interest in the role of endothelin on vascular function in liver disease. Speculation on the role of endothelin in the pathogenesis of acute renal failure, including hepatorenal syndrome, has also been spec...

A critical appraisal and clinical application of Skagen C, Einstein M, Lucey MR, Said A. Combination treatment with octreotide, midodrine, and albumin improves survival in patients with type 1 and type 2 hepatorenal syndrome. J Clin Gastroenterol. 2009 Aug;43(7):680-5. doi: 10.1097/MCG.0b013e318188947c

Combined liver and kidney transplant (CLKT) is the procedure of choice for patients with both liver and kidney end-stage-disease. In addition, patients with polycystic liver or kidney disease or with hyperoxaluria, or those with cirrhosis and acute renal failure, including hepatorenal syndrome receiving hemodialysis (HD) for more than two months, may also benefit of CLKT. The decision to transp...

There is a need to reassess the application of MELD and the impact of renal insufficiency with consideration for developing an algorithm with exception points that would lead to timely allocation of livers to patients with hepatorenal syndrome prior to occurrence of permanent renal damage without jeopardizing post-transplant survival.

Hyperdynamic circulation as well as increased hepatic larly regarding portal pressure, has not been fully elucidated yet. Therefore, mainly ET-1 will be covered in the resistance contribute to portal hypertension in cirrhosis of the liver [1]. Hyperdynamic circulation with increased following text. cardiac output, heart rate and plasma volume and decreased arterial blood pressure and systemic v...

Hepatorenal syndrome (HRS) is a common complication of advanced cirrhosis characterized not only by renal failure but also by marked alterations in systemic haemodynamics and activity of endogenous vasoactive systems. Renal failure is due to a severe vasoconstriction of the renal circulation. The pathogenesis of HRS is not completely understood but it is probably the result of extreme underfill...