Hepatorenal syndrome

Management of Cirrhosis and Associated Complications

Liver cirrhosis is the encapsulation or replacement of injured tissue by collagen, resulting in end-stage liver disease and portal hypertension. The consequences of cirrhosis are impaired hepatocyte function, increase intrahepatic circulatory resistance, portal hypertension, and the development of hepatocellular carcinoma. Complications include encephalopathy, coagulopathy, varices, ascites, spontaneous bacterial peritonitis, epatorenal syndrome, and hepatopulmonary syndrome. Managing patients with acute or chronic liver failure is challenging, and liver failure may have profound effects on other organ systems. Most therapies are directed at managing the complications and bridging patients to liver transplantation. The clinician must be aware of the pathologic presentations and the appropriate management, including pharmacologic and nonpharmacologic therapies, goals and end points of therapy, and monitoring of therapy. This review focuses on the management of the complications directly associated with liver dysfunction (encephalopathy and coagulopathy) and portal hypertension (varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome).

Type I inositol 1, 4, 5-triphosphate receptors increase in kidney of mice with fulminant hepatic failure

AIM: To delineate the mechanisms of renal vasocon-striction in hepatorenal syndrome (HRS), we investigated the expression of typeIinositol 1, 4, 5-triphosphate receptors (IP₃RI) of kidney in mice with fulminant hepatic failure (FHF).

METHODS: FHF was induced by lipopolysaccharide (LPS) in D-galactosamine (GalN) sensitized BALB/c mice. There were 20 mice in normal saline (NS)-treated group, 20 mice in LPS-treated group, 20 mice in GalN-treated group, and 60 mice in GalN/LPS-treated group (FHF group). Liver and kidney tissues were obtained at 2, 6, and 9 h after administration. The liver and kidney specimens were stained with hematoxylin-eosin for studying morphological changes under light microscope. The expression of IP₃RIin kidney tissue was tested by immunohistochemistry, Western blot and reverse transcription (RT)-PCR.

RESULTS: Kidney tissues were morphologically normal at all time points in all groups. IP₃RIproteins were found localized in the plasma region of glomerular mesangial cells (GMC) and vascular smooth muscle cells (VSMC) in kidney by immunohistochemical staining. In kidney of mice with FHF at 6 h and 9 h IP₃RIstaining was up-regulated. Results from Western blot demonstrated consistent and significant increment of IP₃RIexpression in mice with FHF at 6 h and 9 h (t = 3.16, P < 0.05; t = 5.43, P < 0.01). Furthermore, we evaluated IP₃RImRNA expression by RT-PCR and observed marked up-regulation of IP₃RImRNA in FHF samples at 2 h, 6 h and 9 h compared to controls (t = 2.97, P < 0.05; t = 4.42, P < 0.01; t = 3.81, P < 0.01).

CONCLUSION: The expression of IP₃RIprotein increased in GMC and renal VSMC of mice with FHF, possibly caused by up-regulation of IP₃RImRNA.