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Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems
Author(s) -
Guevara Mónica,
Ginès Pere,
Bandi Juan Carlos,
Gilabert Rosa,
Sort Pau,
Jiménez Wladimiro,
GarciaPagán Juan Carlos,
Bosch Jaume,
Arroyo Vicente,
Rodés Juan
Publication year - 1998
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510280219
Subject(s) - hepatorenal syndrome , transjugular intrahepatic portosystemic shunt , vasoactive , medicine , renal function , shunt (medical) , portal hypertension , cardiology , cirrhosis
Little information exists on the effects of transjugular intrahepatic portosystemic shunts (TIPS) in the management of cirrhotic patients with hepatorenal syndrome (HRS). The current study was aimed to prospectively evaluate the effects of TIPS on renal function and vasoactive systems in patients with type I HRS. Glomerular filtration rate (GFR) (inulin clearance), renal plasma flow (RPF) (para‐aminohippurate clearance), plasma renin activity (PRA), aldosterone (ALDO), norepinephrine (NE), and endothelin (ET) were determined in baseline conditions and at different time intervals after TIPS in 7 patients with type I HRS. TIPS induced a marked reduction of portal pressure gradient (PPG) (20 ± 1 to 10 ± 1 mm Hg; P < .05). Renal function improved in 6 of the 7 patients. Serum creatinine and blood urea nitrogen (BUN) decreased from 5 ± 0.8 and 109 ± 7 to 1.8 ± 0.4 mg/dL and 56 ± 11 mg/dL, respectively ( P < .05 for both), and GFR and RPF increased from 9 ± 4 and 103 ± 33 to 27 ± 7 mL/min and 233 ± 40 mL/min, respectively ( P < .05 for both), 30 days after TIPS. These beneficial effects on renal function were associated with a significant ( P < .05) reduction of PRA (18 ± 5 to 3 ± 1 ng/mL · h), ALDO (279 ± 58 to 99 ± 56 ng/dL), and NE (1,257 ± 187 to 612 ± 197 pg/mL). ET did not change significantly (28 ± 8 to 27 ± 11 pg/mL). Mean survival was 4.7 ± 2 months (0.3‐17 months). Three patients remained alive more than 3 months after TIPS insertion. In conclusion, TIPS improves renal function and reduces the activity of the renin‐angiotensin and sympathetic nervous systems in cirrhotic patients with type I HRS. Nevertheless, the efficacy of TIPS in the management of these patients should be confirmed in controlled investigations.