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The Role of Vasoconstrictors in Treating Cirrhosis-Related Kidney Failure – Renal Disorders
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id="primary"> <main class="site-main" id="main"> <article id="post-83" class="post-83 post type-post status-publish format-standard has-post-thumbnail hentry category-kidney-failure tag-albumin-therapy tag-cirrhosis tag-hepatorenal-syndrome tag-midodrine tag-noradrenaline tag-renal-failure tag-splanchnic-vasodilation tag-terlipressin tag-vasoconstrictor-therapy" itemtype="https://schema.org/CreativeWork" itemscope> <div class="inside-article"> <div class="featured-image page-header-image-single "> <img width="2560" height="1340" src="https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-scaled.jpg" class="attachment-full size-full" alt="" itemprop="image" decoding="async" fetchpriority="high" srcset="https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-scaled.jpg 2560w, https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-300x157.jpg 300w, https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-1024x536.jpg 1024w, https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-768x402.jpg 768w, https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-1536x804.jpg 1536w, https://renaldisorders.com/archive/wp-content/uploads/2024/11/banner-40-min-2048x1072.jpg 2048w" sizes="(max-width: 2560px) 100vw, 2560px" /> </div> <header class="entry-header"> <h1 class="entry-title" itemprop="headline">The Role of Vasoconstrictors in Treating Cirrhosis-Related Kidney Failure</h1> <div class="entry-meta"> <span class="posted-on"><time class="entry-date published" datetime="2024-11-16T13:50:25+05:30" itemprop="datePublished">November 16, 2024</time></span> <span class="byline">by <span class="author vcard" itemprop="author" itemtype="https://schema.org/Person" itemscope><a class="url fn n" href="https://renaldisorders.com/archive/author/renaldisorders/" title="View all posts by renaldisorders" rel="author" itemprop="url"><span class="author-name" itemprop="name">renaldisorders</span></a></span></span> </div> </header> <div class="entry-content" itemprop="text"> <p><span style="font-weight: 400;">This complication is known as hepatorenal syndrome, and this seems to be the most difficult complication in patients with cirrhosis. It occurs mainly by renal vasoconstriction and decreased renal blood flow. In such a case, the kidney structure seems normal; however, the patients have a functionally failed kidney due to failure of proper circulation from the liver. Therefore, treatment of cirrhosis-induced renal failure is not limited to the cause alone but also incorporates symptoms declining the kidneys. Besides the rest of the therapeutic interventions, vasoconstrictors have become a requisite intervention towards the improvement of renal function due to them acting via the constriction of blood vessels and reversal of systemic vasodilation caused by cirrhosis in ensuring an adequate flow of blood to the kidneys.</span></p> <h4><b>Understanding Hepatorenal Syndrome and Cirrhosis-Related Kidney Failure</b></h4> <p><span style="font-weight: 400;">Hepatorenal syndrome (HRS) is one of the kidney dysfunction forms in patients suffering from advanced liver disease, usually cirrhosis with ascites. Such a condition is considered a functional disorder because its causes do not come from structural damage to the kidneys but from severe circulatory failure. There are two types: Type 1: suddenly progressive and fatal without treatment; and Type 2: milder but a major contributor to morbidity in cirrhotic patients. In HRS, renal perfusion caused by extreme systemic vasodilation primarily in the splanchnic circulation constricts the kidneys.</span></p> <p><span style="font-weight: 400;">The pathogenesis of HRS is a complex interplay among the liver, kidney, and cardiovascular system. Overproduction of vasodilators, like nitric oxide, triggers splanchnic vasodilation in cirrhosis. This, once again, results in a relative hypovolemia even though fluids are retained; therefore, the kidneys retain sodium and water to maintain the perfusion. The compensatory mechanism involves renal vasoconstriction that occurs as a result of systemic blood pressure decrements. This reduces the blood flow to the kidneys over time, leading to a decrease in the glomerular filtration rate and resulting in kidney failure eventually.</span></p> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Yearwise Publication Trend on <b>“<a href="https://renaldisorders.com/publication-trends/index/kidney failure" target="_blank" title="kidney failure - yearwise publication trends">kidney failure</a>”</b></h2> </div> </div><div class="results-container"><div class="chart-block" style="padding:15px;"> <div class="left"> <div id="results" class="results"></div> </div> <div class="right"> <div class="chart-container"><canvas id="publicationChart"></canvas></div> </div> <div class="keywordsdiv"> <div style="text-align:center;"><b>Find publication trends on relevant topics</b> </div> <span class="gp-icon icon-tags"><svg viewBox="0 0 512 512" aria-hidden="true" xmlns="http://www.w3.org/2000/svg" width="1em" height="1em"><path d="M20 39.5c-8.836 0-16 7.163-16 16v176c0 4.243 1.686 8.313 4.687 11.314l224 224c6.248 6.248 16.378 6.248 22.626 0l176-176c6.244-6.244 6.25-16.364.013-22.615l-223.5-224A15.999 15.999 0 00196.5 39.5H20zm56 96c0-13.255 10.745-24 24-24s24 10.745 24 24-10.745 24-24 24-24-10.745-24-24z"></path><path d="M259.515 43.015c4.686-4.687 12.284-4.687 16.97 0l228 228c4.686 4.686 4.686 12.284 0 16.97l-180 180c-4.686 4.687-12.284 4.687-16.97 0-4.686-4.686-4.686-12.284 0-16.97L479.029 279.5 259.515 59.985c-4.686-4.686-4.686-12.284 0-16.97z"></path></svg></span> <span id="keyword-stats"></span> </div> </div></div></div><div class="inside-article"><style> table { margin: 0 0 1.5em; 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if (!statistics || Object.keys(statistics).length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var tableHTML = `<div class='pub-scroll'> <table class='tablediv' border='1' cellspacing='0' cellpadding='0'> <tr> <th>Year</th> <th>Publication Count</th> </tr>`; Object.entries(statistics).sort(([yearA], [yearB]) => yearB - yearA).forEach(([year, count]) => { const displayCount = count === 0 ? 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Terlipressin works by stimulating the vascular smooth muscle via vasopressin V1 receptors, leading to vasoconstriction mainly in the splanchnic circulation. Redirection of blood flow thus helps restore perfusion to the kidneys and aids the performance of better functioning kidneys. Other vasoconstrictors include noradrenaline and midodrine that may often be administered with albumin, which enhances plasma volume expansion and supports further kidney perfusion.</span></p> <p><span style="font-weight: 400;">The principle underlying the administration of these vasoconstrictors is that they may be used to reverse the hemodynamic alterations instituted by cirrhosis. Indeed, such agents could potentially provide correction of mean arterial pressure, the significant determinant of the preservation of renal function. Vasoconstrictors reduce the increased splanchnic pooling characteristic of cirrhosis by producing an increase in systemic vascular resistance and promoting renal blood flow while limiting the potential for vasoconstriction.</span></p> <h4><b>Terlipressin: The Miracle Drug in the Treatment of HRS</b></h4> <p><span style="font-weight: 400;">Terlipressin is one of the most powerful agents used in treating HRS, especially Type 1. Clinical reports have shown that terlipressin, especially when paired with albumin therapy, can actually reverse kidney failure in the majority of affected patients. The effective functioning of this drug to restore circulatory flow without significant systemic adverse effects makes it much safer than other vasoconstrictors.</span></p> <p><span style="font-weight: 400;">A meta-analysis of randomized controlled trials of patients suffering from Type 1 HRS found that terlipressin was exceptionally effective when used along with albumin. Terlipressin combined with albumin, unlike its use independently or with other agents, could work wonders and prolong survival in those patients who otherwise would have little chance of survival without liver transplantation. Much debate exists over whether terlipressin prolongs survival into the long term, but its stabilization of the patient with an improvement in short-term outcomes is well documented.</span></p> <p><span style="font-weight: 400;">Typically, the dose of terlipressin is titrated with increments to titrate the severity of the HRS; meanwhile, the dose is adjusted by the response of the patient. Basically, it always begins at a dose, and if the serum creatinine did not improve for a given time, the dose was doubled. With this approach, fine-tuning of treatment is done with minimal risks of side effects but maximized therapeutic benefits.</span></p> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Recent Publications on <b>“<a href="https://renaldisorders.com/recent-publications/index/kidney failure" target="_blank" rel="noopener" title="kidney failure - yearwise publication list">kidney failure</a>”</b></h2> </div> </div> <div class="pb-main"><div class="article-scroll"><div id="results_recent" class="results"></div></div><div class="keywordsdiv" style="margin: 0px 15px;margin-top:20px;"> <div style="text-align:center;"><b>Find publications on relevant topics</b> </div> <span class="gp-icon icon-tags"><svg viewBox="0 0 512 512" aria-hidden="true" xmlns="http://www.w3.org/2000/svg" width="1em" height="1em"><path d="M20 39.5c-8.836 0-16 7.163-16 16v176c0 4.243 1.686 8.313 4.687 11.314l224 224c6.248 6.248 16.378 6.248 22.626 0l176-176c6.244-6.244 6.25-16.364.013-22.615l-223.5-224A15.999 15.999 0 00196.5 39.5H20zm56 96c0-13.255 10.745-24 24-24s24 10.745 24 24-10.745 24-24 24-24-10.745-24-24z"></path><path d="M259.515 43.015c4.686-4.687 12.284-4.687 16.97 0l228 228c4.686 4.686 4.686 12.284 0 16.97l-180 180c-4.686 4.687-12.284 4.687-16.97 0-4.686-4.686-4.686-12.284 0-16.97L479.029 279.5 259.515 59.985c-4.686-4.686-4.686-12.284 0-16.97z"></path></svg></span> <span id="keyword-papers"></span> </div></div></div><div class="inside-article"> <style> .pb-main{ border: solid 1px #ccc; border-top: none; margin-bottom: 20px; padding-bottom: 25px; background:#fff; } .author-main { border: solid 1px #ccc; border-top: none; margin-bottom: 20px; padding-bottom: 25px; background:#fff; } .publication-block { padding: 10px; margin-bottom: 10px; background-color: #f9f9f9; text-align: left; background: #FFF; border-bottom: solid 1px #ccc; margin-left: 15px; margin-right: 15px; } .publication-block h3 { margin: 0 0 10px; color: #000!important; } .publication-block a { font-size: 16px !important; line-height: 1em; font-weight: 600; text-transform: none; color: #000; padding: 0px; } .publication-block a:hover{ color: #227cdc; text-decoration:underline; } .article-scroll { max-height: 445px; overflow-y: auto; overflow-x: hidden; } ::-webkit-scrollbar-track { -webkit-box-shadow: inset 0 0 6px rgba(0,0,0,0.3); background-color: #efefef; border-radius:30px; } ::-webkit-scrollbar { width: 6px; background-color: #efefef; border-radius:30px; } ::-webkit-scrollbar-thumb { background-color: #ababab; border-radius:30px; } .publication-block p { margin-bottom: .5em; font-size: 15px; color: #000; } h3 { font-size: 18px !important; margin-bottom: 20px; line-height: 1.2em; font-weight: 600; text-transform: none; } a { padding: 5px; color: #a71c49; } #keyword-papers{ margin-top: 20px; text-align: center; } </style> <script> function decodeString(str) { str = str.replace(/\\'/g, "'"); str = str.replace(/\\'/g, "'"); str = str.replace(/\\'/g, "'"); return str; } function displayResults_recent(papers) { var resultsContainer = document.getElementById('results_recent'); if (!papers || papers.length === 0) { resultsContainer.innerHTML = '<p>No recent publications found.</p>'; return; } papers.forEach(paper => { var publicationBlock = document.createElement('div'); publicationBlock.className = 'publication-block'; var title_de = decodeString(paper.title); var publicationHTML = ` <div style="margin-bottom: 10px;line-height: 24px;"><a href="${paper.url}" target="_blank" title="${title_de}">${title_de}</a></div> <p><strong>Issue Release:</strong> ${paper.publishedDate}</p> `; publicationBlock.innerHTML = publicationHTML; resultsContainer.appendChild(publicationBlock); }); } function displayKeywordPapers(keywords) { var resultsContainer = document.getElementById('keyword-papers'); resultsContainer.innerHTML = ''; if (!keywords || keywords.length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var keywordHTML = ''; keywords.forEach((key, index) => { let key_replace = key.replace(/ /g, '-'); key_replace = key_replace.toLowerCase(); keywordHTML += `<a href="https://renaldisorders.com/recent-publications/index/${key_replace}" target="_blank" title="${key} - publication list">${key}</a>`; if (index < keywords.length - 1) { keywordHTML += ', '; } }); resultsContainer.innerHTML = keywordHTML; } // Call the function with the PHP data var recent_papers = [ { "title": "Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38945140", "publishedDate": "2024" }, { "title": "Clonal hematopoiesis of indeterminate potential contributes to accelerated chronic kidney disease progression.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38946975", "publishedDate": "2024" }, { "title": "A Rare and Unusual Case of Hypernatremic Dehydration in a Newborn Presenting With Adrenal Haemorrhage and Leading to Acute Kidney Injury.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38947616", "publishedDate": "2024" }, { "title": "Chronic Kidney Disease Study in Diabetic Patients: Insights From Primary Care Units in Northern Portugal.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38947587", "publishedDate": "2024" }, { "title": "IGF2BP3\/NCBP1 complex inhibits renal tubular senescence through regulation of CDK6 mRNA stability.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38945255", "publishedDate": "2024" }, { "title": "Management of Massive Flank Hernia After Lateral Lumbar Fusion: Preoperative Botulinum Toxin Injections and Open Repair - A Case Report.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38946127", "publishedDate": "2024" }, { "title": "Role of Point-of-Care ultrasound (POCUS) in clinical hepatology.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38954829", "publishedDate": "2024" }, { "title": "[Chronic kidney disease and accelerated aging: the role of comprehensive geriatric assessment.]", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38944781", "publishedDate": "2024" }, { "title": "Pantoea dispersa peritoneal dialysis catheter-related infection.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38844354", "publishedDate": "2024" }, { "title": "Incident heart failure and the subsequent risk of progression to end stage kidney disease in individuals with type 2 diabetes.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38879473", "publishedDate": "2024" }, { "title": "Fat-free mass derived from bioimpedance spectroscopy and computed tomography are in good agreement in patients with chronic kidney disease.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38848806", "publishedDate": "2024" }, { "title": "Association of myosteatosis with short-term outcomes in patients with acute-on-chronic liver failure.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38871846", "publishedDate": "2024" }, { "title": "Minimisation of dialysis risk in hospital patients with chronic kidney disease (MinDial): study protocol for a multicentre, stepped-wedge, cluster-randomised controlled trial.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38849916", "publishedDate": "2024" }, { "title": "Age-related white matter change disease predicts long-term cerebrovascular morbidity following carotid endarterectomy.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38875944", "publishedDate": "2024" }, { "title": "Mechanism of Zhenwu Decoction modulating TLR4\/NF-\u03baB\/HIF-1\u03b1 loop through miR-451 to delay renal fibrosis in type 2 CRS.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38851985", "publishedDate": "2024" }, { "title": "Effectiveness and safety of modified fully oral 9-month treatment regimens for rifampicin-resistant tuberculosis: a prospective cohort study.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38880112", "publishedDate": "2024" }, { "title": "The role of urine chloride in acute heart failure.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38890417", "publishedDate": "2024" }, { "title": "Stem cell-based therapy for fibrotic diseases: mechanisms and pathways.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38886859", "publishedDate": "2024" }, { "title": "II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38890752", "publishedDate": "2024" }, { "title": "Diagnosis and management of resistant hypertension.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38897628", "publishedDate": "2024" } ]; var keywordsArray = ["Hepatorenal Syndrome","Cirrhosis","Terlipressin","Vasoconstrictor Therapy","Noradrenaline","Midodrine","Renal Failure","Albumin Therapy","Splanchnic Vasodilation"]; displayResults_recent(recent_papers); displayKeywordPapers(keywordsArray); // function stripslashes(str) { // if (typeof str === 'string') { // return str.replace(/\/g, ''); // } // } </script></p> <h4><b>Other Vasoconstrictors: Noradrenaline and Midodrine</b></h4> <p><span style="font-weight: 400;">Although terlipressin is still the first-line drug for the treatment of HRS, other vasoconstrictors such as noradrenaline and midodrine have also recently been shown to be effective, especially in areas where terlipressin is not available or is not indicated for a specific patient. Noradrenaline is an adrenergic agonist that has been studied as an alternative to terlipressin because of its vasoconstrictive effects. It is thought to induce alpha-1 adrenergic receptor stimulation that leads to an increase in systemic vascular resistance and enhancement of renal perfusion.</span></p> <p><span style="font-weight: 400;">This comparative efficacy of noradrenaline and terlipressin in this study indicates that the drugs are equivalent when used to reverse HRS. Therefore, it is a valid alternative source, especially in locations where funding is a challenge. Additionally, the cost is cheaper than that of terlipressin, hence a more viable option in places that spend quite a lot on healthcare.</span></p> <p><span style="font-weight: 400;">Another vasoconstrictor often administered in combination with octreotide and albumin is midodrine, especially in HRS patients. The drug midodrine, as its name implies, refers to an alpha-adrenergic agonist that results in improved vascular tone and blood pressure. Octreotide, a somatostatin analogue, results in improved renal function, mediated by inhibiting the release of vasodilators like glucagon. Therapy with the combination of this drug has proven to be associated with improved renal function in Type 1 and Type 2 HRS patients. However, in contrast to terlipressin, the evidence with regard to the use of the former is relatively weak.</span></p> <h4><b>Combination Therapies in HRS Treatment</b></h4> <p><span style="font-weight: 400;">In addition to the vasoconstrictor monotherapy, combination treatments have had impressive uses in treating HRS. The combination of octreotide, midodrine, and albumin has been studied in both type 1 and type 2 HRS and has led to better renal function and survival in some patients. Such combination therapy raises vascular tone by administering midodrine simultaneously, diminishes vasodilatory mediators through octreotide use, and expands plasma volume through its use of albumin.</span></p> <p><span style="font-weight: 400;">In well-responding patients with combination therapy, serum creatinine and urine output show substantial improvement to be two major markers of renal function. Marked effects were noted only in patients suffering from Type 2 HRS, where the pace of disease progression slows and renal improvement can follow at a gentle pace.</span></p> <p><span style="font-weight: 400;">While these therapies have been generally successful, it is worth noting that vasoconstrictor therapies are often considered transient measures in the treatment of HRS, or bridging measures to liver transplantation. Many patients who show an initial response to vasoconstrictors will eventually go on to need a liver transplant to take care of their underlying liver disease.</span></p> <h4><b>Limitations and Side Effects of Vasoconstrictor Therapy</b></h4> <p><span style="font-weight: 400;">Vasoconstrictors are useful in the treatment of cirrhosis-related renal failure; however, they are not devoid of their side effects. These include hypertension, cardiac arrhythmias, and ischemic complications in the presence of pre-existing cardiovascular diseases. Treatment should thus be monitored to prevent complications associated with excessive vasoconstriction.</span></p> <p><span style="font-weight: 400;">Another major side effect of vasoconstrictor therapy is the huge difference in the response among various groups of patients. Terlipressin and the other vasoconstrictors are highly effective in Type 1 HRS, but their role in Type 2 HRS is not well defined, and the duration of response to these drugs may vary considerably among patients. Such patients also have severe cardiovascular dysfunction and, hence, cannot tolerate these drugs satisfactorily and would pose an added difficulty to treatment.</span></p> <h4><b>Conclusion</b></h4> <p><span style="font-weight: 400;">Vasoconstrictor drugs now play an essential role in the management of cirrhosis-related kidney failure, hepatorenal syndrome being one of the most important applications. Terlipressin remains the gold standard treatment for Type 1 HRS, with important improvements of renal function and survival within the short term. Noradrenaline and midodrine offer further valid alternatives, particularly when terlipressin is not available. Combination therapies with vasoconstrictors, octreotide and albumin, are promising in bridging to liver transplantation for managing both Type 1 and Type 2 HRS. Vasoconstrictors are not without monitoring and are generally included in a multi-faceted treatment designed to treat complications rather than definitive treatments for cirrhosis and its consequences.</span></p> <p></p> <h4><b>References</b></h4> <ol> <li>Sagi, S.V., Mittal, S., Kasturi, K.S. and Sood, G.K., 2010. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1746.2009.06132.x">Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta‐analysis of randomized controlled trials.</a> <i>Journal of gastroenterology and hepatology</i>, <i>25</i>(5), pp.880-885.</li> <li>Gluud, L.L., Christensen, K., Christensen, E. and Krag, A., 2010. <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.23286">Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome.</a> <i>Hepatology</i>, <i>51</i>(2), pp.576-584.</li> <li>Nazar, A., Pereira, G.H., Guevara, M., Martín‐Llahi, M., Pepin, M.N., Marinelli, M., Solá, E., Baccaro, M.E., Terra, C., Arroyo, V. and Ginès, P., 2010. <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.23283">Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome.</a> <i>Hepatology</i>, <i>51</i>(1), pp.219-226.</li> <li>Wong, F., Nadim, M.K., Kellum, J.A., Salerno, F., Bellomo, R., Gerbes, A., Angeli, P., Moreau, R., Davenport, A., Jalan, R. and Ronco, C., 2011. <a href="https://gut.bmj.com/content/60/5/702.short">Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis.</a> <i>Gut</i>, <i>60</i>(5), pp.702-709.</li> <li>Ginès, P. and Schrier, R.W., 2009. <a href="https://www.nejm.org/doi/abs/10.1056/NEJMra0809139">Renal failure in cirrhosis</a>. <i>New England Journal of Medicine</i>, <i>361</i>(13), pp.1279-1290.</li> <li>Camus, C., Lavoué, S., Gacouin, A., Compagnon, P., Boudjéma, K., Jacquelinet, C., Thomas, R. and Le Tulzo, Y., 2009. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1744-9987.2009.00708.x">Liver transplantation avoided in patients with fulminant hepatic failure who received albumin dialysis with the molecular adsorbent recirculating system while on the waiting list: impact of the duration of therapy. </a><i>Therapeutic Apheresis and Dialysis</i>, <i>13</i>(6), pp.549-555.</li> <li>Seo, Y.S., Jung, E.S., An, H., Kim, J.H., Jung, Y.K., Kim, J.H., Yim, H.J., Yeon, J.E., Byun, K.S., Kim, C.D. and Ryu, H.S., 2009. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1478-3231.2009.02105.x">Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels.</a> <i>Liver International</i>, <i>29</i>(10), pp.1521-1527.</li> </ol> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Top Experts on “<b style="color:#000;font-size:22px;">kidney failure</b>“</h2> </div> </div><div class="author-main"><div id="results_author"></div><div style="text-align: center;"><a class="register-button" href="https://renaldisorders.com/expert-search" target="_blank" rel="noopener">Find experts on any field</a></div></div><div class="inside-article" style="background: none;border: none;box-shadow: none;margin-top: -70px;"> <style> .author-block { padding: 15px; 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