Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Glomerular filtration rate and renal plasma flow may be normal, reduced or increased in cirrhosis. The mechanism of departures from normal is not known. Other renal functional changes in cirrhosis include avid sodium reabsorption, impaired concentrating and diluting abilities, and partial renal tubular acidosis. Fluid and electrolyte disorders are common. Sodium retention with edema and ascites should generally be treated conservatively because they tend to disappear as the liver heals and because forced diuresis has hazards. The indications for diuretics are (1) incipient or overt atelectasis; (2) abdominal distress; and (3) possibility of skin breakdown. Hyponatremia is common and its mechanism and treatment must be assessed in each patient. Hypokalemia occurs and requires treatment. Respiratory alkalosis and renal tubular acidosis seldom need therapy. The hepatorenal syndrome is defined as functional renal failure in the absence of other known causes of renal functional impairment. The prognosis is terrible and therapy is unsatisfactory. The best approach is not to equate the occurrence of renal failure in cirrhosis with the hepatorenal syndrome. Rather the physician should first explore all treatable causes of renal failure, eg, dehydration, obstruction, infection, heart failure, potassium depletion, and others.
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PMID:Fluid and electrolyte disturbances in cirrhosis. 96 15

Captopril, the competitive inhibitor of angiotensin-converting enzyme, has proved efficient in the treatment of arterial hypertension and heart failure. Its use is generally associated with low incidence of adverse reactions and hepatic injury has not been emphasized as an important adverse reaction in Denmark. However worldwide, several cases of hepatic injury have been reported. We report one case of Captopril-induced hepatic injury. Despite discontinuation of Captopril a hepatorenal syndrome developed and the patient died five weeks after admission. This report emphasizes the need to be aware of the possibility of hepatic injury in patients receiving Captopril.
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PMID:[Captopril-induced toxic hepatitis]. 141 40

A variant of hepatorenal syndrome occurring in patients with chronic congestive heart failure following an episode of cardiogenic pulmonary edema, and in the absence of hypotension, is described. This was observed in 13 patients during an eleven-year period. The clinical picture is characterized by hepatic injury and functional renal impairment. Increase of serum glutamic oxaloacetic transaminase levels as high as 2100 IU; prolongation of prothrombin time; elevation of serum bilirubin, creatinine, blood urea nitrogen, and potassium levels; decrease in urinary sodium excretion; and a normal urinary sediment are the salient laboratory abnormalities of this entity. Treated with conventional medication, the patients' course was fatal in 4 cases. When the splanchnic vasodilator dopamine was added to the patients' management, 5 of 9 patients recovered. Cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure. The apparently beneficial effect of low-dose dopamine needs further evaluation.
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PMID:Cardiogenic hepatorenal syndrome. 224 92

The infusion of ascitic fluid from the peritoneal cavity into the central venous circulation may relieve massive intractible ascites, and improve renal function when hepatorenal syndrome is present. preoperative preparation of these patients includes investigation of hepatic, renal, pulmonary, cardiac and neurological function, correction of electrolyte and coagulation abnormalities, restoration of normal fluid balance and the provision of supplemental vitamins and calories. Premedication is achieved with an oral benzodiazepine or an intramuscular injection of a narcotic agent. General anaesthesia is provided by thiopentone, suxamethonium, nitrous oxide, oxygen, pancuronium and a narcotic, with intermittent positive pressure ventilation. Close monitoring of cardiac, respiratory and renal function is imperative perioperatively. Postoperatively, supervision in an Intensive Care Unit is advised as complications such as cardiac failure, septicaemia and disseminated intravascular coagulation may occur.
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PMID:The anaesthetic and perioperative management of the patient undergoing insertion of a peritoneo-venous shunt. 710 37

The infusion of endothelin to obtain plasma levels as present in sodium-retaining conditions such as heart failure and hepatorenal syndrome has been shown to cause sodium retention and renal vasoconstriction. Whether these renal effects of endothelin could be modulated by the stimulation of nitric oxide production by the infusion of L-arginine was examined. Therefore, the renal and endocrine effects of the systemic administration of endothelin (2.5 ng/kg per minute for 90 min), L-arginine (5 mg/kg per minute for 90 min), or the combination of endothelin and L-arginine were studied in healthy subjects under clearance conditions. During endothelin infusion, plasma endothelin levels rose from 3.0 +/- 0.2 to 14.1 +/- 2.4 pmol/L (P < 0.01). Mean arterial pressure increased by 7 mm Hg (P < 0.01). The effects on renal function were disproportionately large: renal vascular resistance increased from 77.5 +/- 3.2 to 124.1 +/- 6.7 mm Hg/min per liter (P < 0.01), and sodium excretion fell from 178 +/- 30 to 83 +/- 11 mumol/min (P < 0.01). Endothelin had no effect on urinary nitrite excretion. L-Arginine caused a fall in blood pressure of 5 mm Hg (P < 0.01) and decreased renal vascular resistance by 12% (P < 0.05). Sodium excretion increased twofold. This was associated with an increase in urinary nitrite excretion from 112 +/- 36 to 465 +/- 190 nmol/min (P < 0.01), suggesting stimulation of renal nitric oxide production. During the combination of endothelin and L-arginine, urinary nitrite excretion increased similarly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:L-arginine does not prevent the renal effects of endothelin in humans. 770 89

Elevated levels of the vasocontrictor peptide endothelin-1 have been demonstrated in various pathological conditions that are characterized by sodium retention and/or renal vasoconstriction, such as heart failure, hepatorenal syndrome, renal failure and during administration of cyclosporin and radiocontrast. In the present study we studied in seven healthy subjects the renal and endocrine effects of systemic administration of endothelin-1 (0.5, 1.0 and 2.5 ng/kg/min). During endothelin-1 infusion plasma levels rose from 3.2 +/- 0.5 to respectively 5.0 +/- 0.8, 6.2 +/- 0.5 and 8.5 +/- 1.1 pmol/liter, values that can also be observed in physiological and pathological conditions. Infusion of low dosages of endothelin-1, that result in a twofold increase in plasma levels, decreased sodium excretion by 36%, without a significant effect on systemic and renal hemodynamics. Infusion of 2.5 ng/kg/min of endothelin-1 further enhanced sodium retention and, in addition, increased renal vascular resistance by 37%. Blood pressure did not change significantly. Pretreatment with the calcium channel blocker nifedipine caused renal vasodilation, which compensated for the renal vasocontriction by endothelin-1 and prevented sodium retention. Apparently, endothelin-1 participates in volume homeostasis in human, whereas pathophysiological concentrations can contribute to renal vasoconstriction and sodium retention. Calcium channel blockers may protect against these effects of endothelin-1.
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PMID:Effects of endothelin-1 on renal function in humans: implications for physiology and pathophysiology. 796 49

The transjugular intrahepatic portosystemic shunt (TIPS) is an exciting new addition to the therapeutic armamentarium against portal hypertension. It is currently indicated for salvage of patients with active variceal hemorrhage despite sclerotherapy or where sclerotherapy is not feasible. Its use for recurrent episodes of bleeding despite chronic sclerotherapy and for ascites and hepatorenal syndrome remains experimental. It is contraindicated in patients with right-heart failure and portal vein thrombosis. TIPS is not indicated for primary prophylaxis of variceal hemorrhage or portal decompression prior to liver transplantation. TIPS is associated with its unique spectrum of complications which can occasionally be life-threatening. Although initial experience with this procedure is encouraging, a great amount of work remains to be done to fully define its role in clinical practice.
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PMID:Transjugular intrahepatic portosystemic shunt: a medical perspective. 854 79

More than 40,000 cases have been treated with gamma knife radiosurgery, but few neuropathological reports are available. This paper describes two autopsy cases in which the patients had been treated with gamma knife. As these patients died 67 and 24 days after therapy, early neuropathological changes are reported. The first case was a 58-year-old woman diagnosed with multiple brain metastases from breast cancer. One of these lesions, in the medullaoblongata, was irradiated with a gamma knife. Sixty-seven days later, she died from heart failure. The second case was a 69-year-old man diagnosed with multiple brain metastases from lung cancer. One of these lesions, in the pons, was irradiated with a gamma knife. Twenty-four days later, he died from acute renal failure caused by hepatorenal syndrome. In both cases, the irradiated lesions were well demarcated from the undamaged surrounding tissues on light microscopy. Histologically, the tumor cells showed a variety of degenerative changes, such as pyknosis, multinuclear cells, and vacuolar degeneration in the cytoplasm. Fibrosis, more prominent in the first case, was observed spreading in the irradiation field, adhering to the hyalinized and thickened vessel walls. Demyelination was also observed in the first case. As far as we know, this report is the first published description of fibrosis in the radiosurgical irradiation field.
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PMID:[Gamma knife radiosurgery for metastatic brain tumors: neuropathological report of two autopsy cases and review of literatures]. 907 94

Among the 165 cases of late-stage liver cancer treated in our hospital, 65 (39.4%) died, with an average survival time of 8.1 months and a median survival time of 7 months. Among the 65 dead patients, 45 were treated with traditional Chinese drugs and 20 with western medicine. The average survival time was 8.4 months in the former and 7.3 months in the latter group. The direct causes of death for the 65 patients were hepatic coma, severe hemorrhage of the upper digestive tract, Heyd's syndrome, hepatorrhexis, respiratory failure, cardiac failure, etc. The incidence rates of hemorrhage of the upper digestive tract and hepatorrhexis in the 45 patients treated with traditional Chinese drugs were obviously lower than those treated with western medicine.
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PMID:An analysis for death causes in 45 cases of liver cancer treated with traditional Chinese drugs. 1068 63

Splanchnic arterial relaxation is the most important pathology in systemic circulation of portal hypertensive patients. Progressive decline of splanchnic vascular resistance is responsible for development of circulatory dysfunction syndrome (CDS), associated with reduction of effective blood volume within central vascular compartment and compensatory stimulation of vasopressor and natrium retaining hormonal mechanisms. Advanced CDS is characterized by increased cardiac output, tachycardia and low arterial pressure. Complications of CDS have functional nature and comprise: renal failure (hepatorenal syndrome), respiratory failure in context of hepatopulmonary syndrome, cardiac insufficiency produced by portopulmonary hypertension or portal cardiomyopathy, hemorrhages from digestive tract caused by hypertensive portal gastropathy or derangements of brain perfusion. The management of CDS relies on adequate filling of vascular system (albumin), constriction of arterial splanchnic vessels (beta-blocker, analogs of vasopressin and somatostatin), reduction of cardiac output (beta-blocker) and giving support to local vasoprotective mechanisms (prostaglandins, nitric oxide, blockade of ET-A receptors).
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PMID:[Circulatory dysfunction syndrome associated with liver cirrhosis]. 1619 May 66


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