Effect of transjugular intrahepatic portosystemic shunt (TIPS) on renal function and vasoactive systems in hepatorenal syndrome (SHR)

Hepatology (Impact Factor: 11.19). 01/1998; 28(2):416 - 422. DOI: 10.1002/hep.510280219

ABSTRACT 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.

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Available from: Juan Carlos García-Pagán, Oct 06, 2014
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    • "Additionally, TIPS increases glomerular filtration and urine output, promotes natriuresis, and reduces the plasma rennin activity, aldosterone levels, and noradrenaline levels. All these help in improving the renal function that is altered from advanced cirrhosis [7, 8]. TIPS also improves protein metabolism and nutrition, alongwith an overall improvement in quality of life [9, 10]. "
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    ABSTRACT: Liver cirrhosis is associated with higher morbidity and reduced survival with appearance of portal hypertension and resultant decompensation. Portal decompression plays a key role in improving survival in these patients. Transjugular intrahepatic portosystemic shunts are known to be efficacious in reducing portal venous pressure and control of complications such as variceal bleeding and ascites. However, they have been associated with significant problems such as poor shunt durability, increased encephalopathy, and unchanged survival when compared with conservative treatment options. The last decade has seen a significant improvement in these complications, with introduction of covered stents, better selection of patients, and clearer understanding of procedural end-points. Use of TIPS early in the period of decompensation also appears promising in further improvement of survival of cirrhotic patients.
    07/2011; 2011:398291. DOI:10.4061/2011/398291
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    • "Une méthode non chirurgicale de décompression portale, le shunt intra-hépatique porto-systémique trans-jugulaire (TIPS) a récemment été introduite [11]. Deux études non contrôlées totalisant 21 malades suggèrent que le TIPS pourrait être utile dans le traitement de l'insuffisance rénale des malades atteints de SHR [12] [13]. Cependant, il faut avoir en mémoire qu'une étude contrôlée comparant le TIPS à la paracentèse chez les malades avec une ascite réfractaire ont montré que chez les malades grades C, la mortalité était significativement plus élevée dans le groupe «TIPS» que dans le groupe «paracentèse» [14]. "
    Gastroentérologie Clinique et Biologique 04/2004; 28:130-137. DOI:10.1016/S0399-8320(04)95248-7 · 1.14 Impact Factor
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    ABSTRACT: Preamble These recommendations provide a data-supported ap-proach. They are based on the following: (1) formal re-view and analysis of recently published world literature on the topic (Medline search); (2) The American College of Physicians' Manual for Assessing Health Practices and De-signing Practice Guideline 1 ; (3) policy guidelines, includ-ing the American Association for the Study of Liver Diseases' Policy Statement on Development and use of Practice Guidelines and the American Gastroenterologi-cal Associations' Policy Statement on the Use of Medical Practice Guidelines 2 ; and (4) the authors' years of experi-ence in the care of patients with portal hypertension and use of TIPS in the management of these disorders. These recommendations are fully endorsed by the AASLD and the Society for Interventional Radiology. Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventative aspects of care. They are intended to be flexible, in contrast to standards of care, which are inflexible policies designed to be followed in every case. Specific rec-ommendations are based on relevant published information. In an attempt to characterize the quality of evidence support-ing recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases requires a grade to be assigned and reported with each rec-ommendation (Table 1).
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