Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indic...Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indicator.Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction.Obstructive or post renal dysfunction only rarely complicates liver disease.Hepatorenal syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal histology.Irrespective of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular resistance.Volume expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment.Splanchnic vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in HRS.Continuous renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.展开更多
Multiple organ dysfunction syndrome (MODS) or multiple organ failure ( MOF)is a syndrome which is frequently related to shock and sepsis, and has been described as the mostcommon cause of death in the noncoronary crit...Multiple organ dysfunction syndrome (MODS) or multiple organ failure ( MOF)is a syndrome which is frequently related to shock and sepsis, and has been described as the mostcommon cause of death in the noncoronary critical care unit. The potential pathogenesis of theseptic and systemic inflammatory response syndrome (SIRS) response has been increasingly associatedwith the development and aggravation of MODS or MOF. And studies in this respect have alsodemonstrated that there is a higher risk of mortality associated with some specific organ systemswhen they are dysfunctional, thus leading to the failures of the liver, brain, lung, and kidney. Theliver interacts with many other organ systems, and liver dysfunction may act collectively in theproduction of organ system dysfunction, thus finally ending up with MODS. The management of patientswith MODS/MOF is predominantly supportive and some specific treatments are directed at treating theunderlying disorders. The molecular adsorbent recirculating system (MARS) is an albumin dialysissystem and it was shown to be efficient in removing both hydrosoluble substances and stronglyalbumin-bound substances, so that it improves not only the function of the liver but also that ofother organ systems, and it can be applied to treating the diseased liver as the cause of multipleorgan failure and actively combat deterioration in patients' liver function. This trial aims atevaluating the therapeutic effectiveness of MARS in 39 various pathogenic MODS patients in ourhospital and Beijing Ditan Hospital.展开更多
文摘Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indicator.Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction.Obstructive or post renal dysfunction only rarely complicates liver disease.Hepatorenal syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal histology.Irrespective of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular resistance.Volume expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment.Splanchnic vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in HRS.Continuous renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.
文摘Multiple organ dysfunction syndrome (MODS) or multiple organ failure ( MOF)is a syndrome which is frequently related to shock and sepsis, and has been described as the mostcommon cause of death in the noncoronary critical care unit. The potential pathogenesis of theseptic and systemic inflammatory response syndrome (SIRS) response has been increasingly associatedwith the development and aggravation of MODS or MOF. And studies in this respect have alsodemonstrated that there is a higher risk of mortality associated with some specific organ systemswhen they are dysfunctional, thus leading to the failures of the liver, brain, lung, and kidney. Theliver interacts with many other organ systems, and liver dysfunction may act collectively in theproduction of organ system dysfunction, thus finally ending up with MODS. The management of patientswith MODS/MOF is predominantly supportive and some specific treatments are directed at treating theunderlying disorders. The molecular adsorbent recirculating system (MARS) is an albumin dialysissystem and it was shown to be efficient in removing both hydrosoluble substances and stronglyalbumin-bound substances, so that it improves not only the function of the liver but also that ofother organ systems, and it can be applied to treating the diseased liver as the cause of multipleorgan failure and actively combat deterioration in patients' liver function. This trial aims atevaluating the therapeutic effectiveness of MARS in 39 various pathogenic MODS patients in ourhospital and Beijing Ditan Hospital.
