Acute effects of transjugular intrahepatic portosystemic stent-shunt (TIPSS) procedure on renal blood flow and cardiopulmonary hemodynamics in cirrhosis.

Objective: An acute increase in portal pressure is associated with an immediate reduction in renal blood flow. It has been suggested that this supports the presence of an hepatorenal reflex. In this study, we used TIPSS placement as a model to investigate the effect of an acute reduction in portal pressure on renal blood flow and cardiopulmonary hemodynamic parameters.

Natriuretic effect of an adenosine-1 receptor antagonist in cirrhotic patients with ascites.

Background & Aims: The sodium and water retention and renal vasoconstriction exhibited by patients with cirrhotic ascites are similar to the changes observed by stimulation of renal adenosine 1 receptors. The aim of this study was to investigate the effects of FK352 (an adenosine 1 antagonist) on renal and systemic hemodynamics and renal function in cirrhotic patients with ascites.

Methods: p-Aminohippuric acid and inulin clearance, urine flow rate, sodium and potassium excretion, and free water clearance were measured for 2 hours before and after FK352 administration.

Direct measurement of post-prandial portal haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt.

Objective: Portal haemodynamics vary in response to eating and other stimuli, but any increase in portal venous pressure (PVP) in cirrhotic patients may be a risk factor for variceal bleeding. We directly assessed post-prandial splanchnic haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt (TIPSS) in situ.

Methods: A thermodilution catheter was inserted via the patent TIPSS into the portal vein in 12 cirrhotic patients.

Acute effect of propranolol and isosorbide-5-mononitrate administration on renal blood flow in cirrhotic patients.

Background: Propranolol and isosorbide-5-mononitrate (ISMN) are increasingly used in the prophylaxis of variceal haemorrhage in cirrhosis. However, recent studies have suggested that these drugs may compromise renal function, possibly by reducing renal blood flow.

Aims: To assess the acute effects of propranolol and ISMN on renal blood flow and other haemodynamic parameters in cirrhosis.

Pathophysiology and management of portal hypertension. 2: Cirrhotic ascites.

The pathophysiology of the haemodynamic and renal abnormalities in cirrhosis remains ill-defined. The development of ascites has poor prognostic significance and management should follow a stepwise approach from salt restriction to diuretic therapy then large-volume paracentesis before more invasive techniques.