Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UNIPROT:P01185 (vasopressin)
 23,126 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Terlipressin, a vasopressin agonist, is a commonly used drug with different indications, particularly in patients with end-stage liver disease. As a V(1) receptor agonist, it increases systemic vascular resistance, particularly in the splanchnic area, resulting in a decrease of portal pressure. Besides the approved use for variceal bleeding, terlipressin also has beneficial effects in the treatment of hepatorenal syndrome and norepinephrine-resistant septic shock. In patients with cirrhosis and variceal bleeding, the use of terlipressin reduces the portal vein pressure and decreases the pressure in esophageal varices. This can save lives when skilled endoscopists are not immediately available. Hepatorenal syndrome is associated with vasodilation in the mesenteric circulation with arterial underfilling and consecutive renal vasoconstriction. Restoration of an effective arterial blood volume can be achieved by the combination of terlipressin and volume expansion. In some cases, a success rate of up to 75% is reported. The early use of terlipressin in catecholamine-resistant shock can improve organ perfusion.
 ...
PMID:Pharmacology, clinical efficacy and safety of terlipressin in esophageal varices bleeding, septic shock and hepatorenal syndrome. 1907 11

The hepatorenal syndrome (HRS) is a common complication in advanced liver cirrhosis, and often occurs in patients with ascites and severe circulatory dysfunction. HRS is a functional renal failure which was believed to be the end result of progressive splanchnic vasodilatation. However, recent data have implicated a role of reduced cardiac output as well as endothelial dysfunction in the etiology of HRS. Type 1 HRS is associated with a poor prognosis and often occurs in conjunction with microcirculatory dysfunction in other organs, including the heart, brain and liver. The treatment of type 1 HRS has centered around vasoconstrictors and intravenous hydration, traditionally midodrine and albumin. However, new vasoconstrictors (specifically vasopressin analogues), transjugular intrahepatic portacaval shunts, and albumin dialysis have been introduced as potential therapies. This review will discuss new advances in the diagnosis and pathogenesis of HRS, with an emphasis on the management.
 ...
PMID:The management of hepatorenal syndrome. 1930 78

Both liver and kidney dysfunction are associated with adverse outcomes in critical illness. Advanced liver disease can be complicated by the hepatorenal syndrome (HRS) with liver transplantation offering the best long-term outcome. However, until recently, HRS was associated with such a poor prognosis that this group of patients rarely survived long enough for transplantation to be considered. The use of vasopressin analogues and albumin infusions has improved the management of HRS and outcomes in terms of renal recovery and survival.
 ...
PMID:The liver and kidney in critically ill patients. 1959 Jan 79

Ascites and hepatorenal syndrome (HRS) are the major and challenging complications of cirrhosis and portal hypertension that significantly affect the course of the disease. Liver insufficiency, portal hypertension, arterial vasodilatation, and systemic cardiovascular dysfunction are major pathophysiological hallmarks. Modern treatment of ascites is based on this recognition and includes modest salt restriction and stepwise diuretic therapy with spironolactone and loop diuretics. Tense and refractory ascites should be treated with a large volume paracentesis, followed by volume expansion or transjugular intrahepatic portosystemic shunt. New treatment strategies include the use of vasopressin V(2)-receptor antagonists and vasoconstrictors. The HRS denotes a functional and reversible impairment of renal function in patients with severe cirrhosis with a poor prognosis. Attempts of treatment should seek to improve liver function, ameliorate arterial hypotension and central hypovolemia, and reduce renal vasoconstriction. Ample treatment of ascites and HRS is important to improve the quality of life and prevent further complications, but since treatment of fluid retention does not significantly improve survival, these patients should always be considered for liver transplantation.
 ...
PMID:Pathogenetic background for treatment of ascites and hepatorenal syndrome. 1966 17

Ascites and hyponatremia are frequent complications of advanced liver cirrhosis. Over 50 % of cirrhotic patients develop ascites and about one third gets hyponatremic. The development of ascites is due to an increased sodium retention in the kidneys, leading to expansion of extracellular volume and accumulation of fluid in the peritoneum. Hyponatremia is related to an impairment in the renal capacity to eliminate solute-free water that causes water retention that is disproportionate to the sodium retention, thus causing a reduction in serum sodium concentration. The exact pathogenesis of sodium retention is not clear, yet. The main pathogenic factor responsible for hyponatremia is a nonosmotic hypersecretion of vasopressin from the neurohypophysis. There is evidence suggesting that hyponatremia predisposes to hepatic encephalopathy. Impairment in glomerular filtration rate in hepatorenal syndrome is due to renal vasoconstriction. Treatment of ascites consists of potassium sparing diuretics, loop diuretics, and/or paracentesis. The current standard of care of hyponatremia based on fluid restriction is unsatisfactory. Currently, a new family of drugs, known as vaptans, which act by specifically antagonizing the effects of vasopressin on the V2 receptors located in the kidney, is evaluated for their role in the management of hyponatremia. Because data on long-term administration are still incomplete, they cannot be used routinely, yet. Liver transplantation is the treatment of choice for hepatorenal syndrome. As bridge to transplantation long-term administration of intravenous albumin and vasoconstrictors can be used.
 ...
PMID:[Treatment of ascites, hyponatremia and hepatorenal syndrome in liver cirrhosis]. 1988 92

Acute deterioration in kidney function often occurs in patients with acute and chronic liver disease admitted to hospital. The true incidence of acute kidney injury (AKI) is unknown due to the difficulty in accurately measuring kidney function in patients with liver failure, and the lack of a consensus definition of AKI. There is a current consensus definition of hepatorenal syndrome (HRS), but in current clinical practice, volume-unresponsive AKI or acute tubular necrosis are much more common causes of AKI in patients with liver disease. Due to arterial vasodilatation and compensatory neuroendocrine activation, these patients are more prone to AKI due to a combination of changes in renal autoregulation and a sudden reduction in effective plasma volume or hypotension. The key management strategy is to prevent the development of HRS, by avoiding nephrotoxins, and preventing infective complications, and maintaining an effective circulating volume. In patients with HRS, treatment centres around daily plasma volume expansion, typically with albumin, in combination with vasopressors, typically vasopressin analogues, such as terlipressin, or noradrenaline. If renal function does not recover, then renal support with dialysis may be appropriate.
 ...
PMID:Management of acute kidney injury in liver disease. 2042 70

Hepatorenal syndrome (HRS) is a severe complication in patients with endstage liver disease. It consists of functional renal vasoconstriction leading to severe reduction of the glomerular filtration rate. In some patients the renal failure shows a rapidly progressive course, a clinical pattern known as type 1 HRS. In other cases the renal failure is less severe and remains stable for months, a condition known as type 2 HRS. HRS is pathogenically related to disturbances in circulatory function, mainly characterized by marked arterial vasodilation of the splanchnic circulation, triggered by portal hypertension. This vasodilation may result in effective arterial underfilling, with subsequent activation of vasoconstrictor systems including the renin-angiotensin system and the sympathetic nervous system, as well as hypersecretion of arginine vasopressin. These compensatory mechanisms may lead to renal failure due to the increase in intrarenal resistance and hypoperfusion. Although the available data are derived from studies including a limited number of patients mainly affected by type 1 HRS, vasoconstrictor drugs, in particular the vasopressin analog terlipressin, seem to be the most effective approach for the management of HRS. Associated with albumin infusion, these drugs have been shown to lead to reduced mortality and improved renal function in type 1 HRS. This is particularly true in HRS patients awaiting liver transplantation in whom the vasoconstrictor drugs appear to be the ''bridging'' therapy of choice. Finally, their use has been shown to be safe, and side effects usually disappear after dose reduction.
 ...
PMID:[The role of terlipressin in hepatorenal syndrome]. 2092 78

Ascites, dilutional hyponatremia and hepatorenal syndrome are three clinical manifestations of the same physiopathological disorder: cirrhotic portal hypertension, hyperproduction of nitric oxide, arterial vasodilation with reduction of efficient arterial volume, which have as consequences renal vasoconstriction, sympathetic stimulation, the stimulation of renin-angiotensin-aldosteron system and of vasopressin secretion. In dilutional hyponatremia, the selective receptor V2 (vasopressin 1) antagonists may be efficient according to Spanish and American specialists and also according to personal experience.
 ...
PMID:The kidney in cirrhosis with portal hypertension. 2096 4

Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and circulatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cirrhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neurohormonal systems. Primarily the sympathetic nervous system and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged activation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal perfusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to reverse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.
 ...
PMID:Terlipressin and hepatorenal syndrome: what is important for nephrologists and hepatologists. 2104 48

Hepatorenal syndrome (HRS) is the most frequent life threatening complication of advanced liver failure and cirrhosis. HRS results from a functional renal dysfunction due to circulatory disturbances in patients with advanced liver disease and portal hypertension. Reduction in the effective circulating blood volume and hence hypoperfusion of the kidney is the basic underlying common pathogenetic mechanism for the development of hepatorenal syndrome. The prognosis for HRS remains very poor with types 1 and 2-both having an expected survival time of 2 weeks and 6 months, respectively. Although the available data are derived from studies including a limited number of patients mainly affected by type 1 HRS, vasoconstrictor drugs, in particular the vasopressin analog Terlipressin, seem to be the most effective approach for the management of HRS. Associated with albumin infusion, these drugs have been shown to lead to reduced mortality and improved renal function in HRS. Terlipressin administration significantly increases mean arterial pressure and systemic vascular resistance; while the heart rate, cardiac output, HVPG and portal venous blood flow decrease significantly. This decrease correlates well with the decrease in plasma renin activity. Thus the vasoconstrictor effect of Terlipressin reverses the basic pathology of HRS by reducing the plasma renin activity. The improvement in hemodynamics with Terlipressin is associated with an increase in glomerular filtration rate and deactivation of the vasoconstrictor and sodium-conserving hormones with reduced activity of the RAAS resulting in increased natriuresis. Terlipressin thus reverses HRS and is useful in bridging the patient to liver transplantation and may hence indirectly improve survival. Patients with HRS who show an improvement in renal function with Terlipressin and albumin seem to have an excellent post-transplantation outcome similar to that of patients without HRS. Thus, the use of Terlipressin has been shown to be safe, with minimal side effects that usually disappear after dose reduction, and results in an improved outcome in patients with HRS.
 ...
PMID:Terlipressin in hepatorenal syndrome: Evidence for present indications. 2119 21


<< Previous 1 2 3 4 5 6 7 8 9 Next >>