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
Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left vent...Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle with the abscence of coronary occlusion, This disease typically occurs in postmenopausal women of an advanced age after emotional or physical stress. Although the prognosis is generally favorable, acute fatal complications have been reported in a small subset of patients. Some patients died with acute cardiac complications, on the other hand, other patients died with underlying critical illness which triggered stress-induced cardiomyopathy.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Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle with the abscence of coronary occlusion, This disease typically occurs in postmenopausal women of an advanced age after emotional or physical stress. Although the prognosis is generally favorable, acute fatal complications have been reported in a small subset of patients. Some patients died with acute cardiac complications, on the other hand, other patients died with underlying critical illness which triggered stress-induced cardiomyopathy.
