Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment , livre ebook

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Ascites is the most frequent and hepatorenal syndrome the most lethal complication in liver cirrhosis. In recent years, major progress has been made regarding effective treatment of these complications, thus reducing mortality in patients.This publication highlights and critically appraises recent achievements and novel advances, and at the same time provides the background needed to grasp novel concepts. Topics treated include complications of paracentesis, the right choice of plasma expanders, and selection of patients who will experience survival benefit from transjugular intrahepatic portosystemic shunt. Hepatorenal syndrome, on the other hand, is responsible for a broad spectrum of manifestations caused by acute kidney injury, which until recently was considered a lethal condition. Drug treatments to improve renal function and prolong survival are therefore also discussed, including important issues for clinical outcome which are still under debate. Moreover, the role of combined kidney-liver transplantation versus conventional liver-only transplantation is addressed, as well as the use of vaptans in hyponatremia and their controversial role in the treatment of ascites.Renowned experts share their knowledge and expertise and provide an international perspective. Their contributions include up-to-date references and a bullet-point summary, making this publication most valuable for practitioners, clinicians and scientists in the field.

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Publié par	S. Karger AG
Date de parution	21 décembre 2010
Nombre de lectures	0
EAN13	9783805595926
Langue	English
Poids de l'ouvrage	1 Mo

Informations légales : prix de location à la page 0,0535€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.

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Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment
Frontiers of Gastrointestinal Research
Vol. 28
Series Editor
Markus M. Lerch Greifswald

Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment
Volume Editor
Alexander L. Gerbes Munich
23 figures and 31 tables, 2011
Frontiers of Gastrointestinal Research
Founded 1975 by L. van der Reis, San Francisco, Calif.
_________________________

Alexander L. Gerbes Klinikum München-Grosshadern Liver Center Munich Ludwig Maximilian University of Munich Munich, Germany

Library of Congress Cataloging–in–Publication Data
Ascites, hyponatremia, and hepatorenal syndrome: progress in treatment/ volume editor, Alexander L. Gerbes Munich.
p.; cm. –– (Frontiers of gastrointestinal research, ISSN 0302–0665 ; v. 28)
Includes bibliographical references and indexes.
ISBN 978–3–8055–9591–9 (hard cover: alk. paper) –– ISBN 978–3–8055–9592–6 (e-ISBN)
1. Liver––Cirrhosis––Complications––Treatment. I. Gerbes, A. L. (Alexander L.) II. Series: Frontiers of gastrointestinal research ; v. 28. 0302–0665
[DNLM: 1. Liver Cirrhosis–complications. 2. Liver Cirrhosis–therapy. 3. Ascites–therapy. 4. Hepatorenal Syndrome–therapy. 5. Hyponatremia–therapy. W1 FR946E v.28 2011/Wl 725]
RC848.C5A83 2011
616.3‘624–dc22
2010032384
Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents ®.
Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2011 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid–free and non–aging paper (ISO 9706) by Reinhardt Druck, Basel
ISSN 0302–0665
ISBN 978–3–8055–9591–9
e-ISBN 978–3–8055–9592–6

Contents
Preface
Gerbes, A.L. (Munich)
Differential Diagnosis of Ascites
Appenrodt, B. (Bonn)
Current Treatment Strategies: Diuretics
Bernardi, M. (Bologna)
Paracentesis
Sanyal, A.J.; Bajaj, J.S.; Shaw, J. (Richmond, Va.)
Large-Volume Paracentesis: Which Plasma Expander?
Terg, R.A. (Buenos Aires)
Albumin: Not Just a Plasma Expander
Davies, N.A.; Garcia, R.; Proven, A.; Jalan, R. (London)
Transjugular Intrahepatic Portosystemic Shunt for Ascites: Which Patients Will Benefit?
Salerno, F.; Cazzaniga, M. (San Donato Milanese)
Spontaneous Bacterial Peritonitis - Prophylaxis and Treatment
Wiest, R. (Regensburg); Garcia-Tsao, G. (New Haven, Conn./West Haven, Conn.)
Clinical Implications of Hyponatremia in Cirrhosis
Heuman, D.M. (Richmond, Va.)
Vaptans for Ascites - Chances and Risks
Wong, F. (Toronto, Ont.)
Cardiorenal Syndrome - A New Entity?
Møller, S.; Krag, A. (Hvidovre)
Renal Failure in Cirrhosis
Gustot, T. (Brussels/Clichy/Paris); Moreau, R. (Clichy/Paris)
Novel Definition of Hepatorenal Syndrome: Clinical Consequences
Fernandez, J.; Arroyo, V. (Barcelona)
Role of Infections in Hepatorenal Syndrome
Wiest, R. (Regensburg)
TIPS for HRS
Sauerbruch, T.; Appenrodt, B. (Bonn)
Vasoconstrictor Therapy for Hepatorenal Syndrome
Yeo, C.-M. (New Haven, Conn.); Garcia-Tsao, G. (New Haven, Conn./West Haven, Conn.)
Terlipressin for Hepatorenal Syndrome: The US Experience
Musana, A.K.; Sanyal, A.J. (Richmond, Va.)
Terlipressin for Hepatorenal Syndrome: Predictors of Response
Cárdenas, A.; Ginès, P. (Barcelona)
Safety of Terlipressin for Hepatorenal Syndrome
Krag, A.; Møller, S. (Hvidovre)
Terlipressin for Hepatorenal Syndrome: Novel Strategies and Future Perspectives
Angeli, P. (Padova)
Hepatorenal Syndrome and Liver Transplantation
Gonwa, T.A. (Jacksonville, Fla.)
Author Index
Subject Index

Preface
In patients with cirrhosis of the liver treatment focuses on the therapy of complications.
Ascites is the most frequent and hepatorenal syndrome the most lethal complication of liver cirrhosis. Fortunately, major progress has been made in recent years in providing effective treatment and thus reducing mortality in these patients. Therefore, the topics of ascites, hyponatremia and hepatorenal syndrome are very well suited to be presented as a book in the Frontiers in Gastrointestinal Research series.
Consequently, this project highlights and critically appraises recent achievements and novel advances. It also provides the background needed to grasp the novel concepts, but is not intended to represent an encyclopedic textbook. Contributions are provided by the most renowned experts at the forefront of clinical research. Their state of the art contributions provide up-to-date references and conclude with a bullet point summary.
Just to pick some of the hot topics that are elaborated in this book. The Transjugular Intrahepatic Portosystemic Shunt (TIPS) and paracentesis, respectively have been introduced into clinical routine, but several pitfalls need to be observed. Chapters deal with the most relevant issues of complications of paracentesis, the right choice of plasma expanders, and selection of patients who will experience survival benefit from TIPS. Beneficial effects of albumin infusion independent of its properties as a plasma expander are discussed.
There is a broad spectrum of acute kidney injury in cirrhosis. Hepatorenal syndrome was considered as a terminal renal failure in cirrhosis until recently. Now, drug treatment can improve renal function and prolong survival - a clinical breakthrough. However, important issues for clinical outcome are still under debate, such as predictors of response and ways to reduce the incidence of side effects of vasoconstrictor therapy. The role of combined kidney-liver transplantation versus conventional liver-only transplantation is considered.
Finally, hyponatremia, an indicator of poor prognosis in cirrhosis can now be addressed with vaptans, new pharmaceutical compounds. The role of vaptans for treating patients with ascites is still a matter of controversy.
I gladly accepted the invitation by Markus Lerch, the series editor, to design and organize this volume, and am very grateful that a highly selected group of international experts has contributed to this book. I do appreciate that despite their extremely busy agenda they took the time to share their knowledge and expertise. They come from the Americas and from Europe and thus provide a truly universal perspective.
It is my hope that this book provides practical advice for practitioners and clinicians who care for patients with cirrhosis. Furthermore, clinicians and scientists working in the field should find the latest data and inspiration for future research.
Alexander L. Gerbes Munich, Germany

Gerbes AL (ed): Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment. Front Gastrointest Res. Basel, Karger, 2011, vol 28, pp 1-10
______________________
Differential Diagnosis of Ascites
B. Appenrodt
Department for Internal Medicine I, University of Bonn, Bonn, Germany
______________________
Abstract
Approximately 80-85% of causes of ascites are related to portal hypertension; however, malignancy-related ascites, cardiac failure and tuberculosis and other less common causes should always be considered. If ascites is suspected the patient should be carefully evaluated, including clinical history and physical examination. Diagnostic paracentesis should be performed routinely to determine the cause of ascites and spontaneous bacterial peritonitis. Basic tests include a cell count with differential and total protein concentration in ascitic fluid. Culture and other optional tests like the serum ascites albumin gradient can be performed based on clinical suspicion. New tests have been developed especially for the diagnosis of spontaneous bacterial peritonitis such as measurement of lactoferrin concentration in ascitic fluid or detection of bacterial DNA. These tests still need to be evaluated further.
Copyright © 2011 S. Karger AG, Basel
Ascites is defined as accumulation of fluid in the peritoneal cavity. It is a