Background: Accumulating evidence has challenged the traditional model of the liver-kidney connection in hepatorenal syndrome. Cirrhosis can significantly impact cardiac function, leading to cirrhotic cardiomyopathy. Recent understanding reveals how cardiac dysfunction plays a pivotal role in the development of renal dysfunction in this setting, suggesting that disturbances traditionally categorized under hepatorenal syndrome may actually represent a hepatic form of cardiorenal syndrome-hepatocardiorenal syndrome-where the liver affects the kidney through cardiorenal pathways.
Summary: Effective management of hepatocardiorenal syndrome and acute kidney injury in cirrhosis relies on accurately assessing a patient's hemodynamic and volume status. Point-of-care ultrasound, including lung and focused cardiac ultrasound, is a valuable diagnostic tool that provides crucial data on fluid tolerance, subclinical pulmonary congestion, and left ventricular filling pressures. This objective, bedside approach offers a comprehensive assessment that directly influences patient management and therapeutic decisions.
Key Messages: Point-of-care ultrasound plays an essential role in evaluating and managing hepatocardiorenal syndrome, providing insights into the underlying pathophysiology. By assessing hemodynamic parameters, it helps guide therapy and monitor patient responses, ensuring more accurate and effective treatment of patients with cirrhosis and acute kidney injury.
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Background: Accumulating evidence has challenged the traditional model of the liver-kidney connection in hepatorenal syndrome. Cirrhosis can significantly impact cardiac function, leading to cirrhotic cardiomyopathy. Recent understanding reveals how cardiac dysfunction plays a pivotal role in the development of renal dysfunction in this setting, suggesting that disturbances traditionally categorized under hepatorenal syndrome may actually represent a hepatic form of cardiorenal syndrome-hepatocardiorenal syndrome-where the liver affects the kidney through cardiorenal pathways.
View Article and Find Full Text PDFSound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis.
World J Crit Care Med
June 2024
Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
Article Synopsis
- - The article addresses the complex issues of acute kidney injury (AKI) in patients with cirrhosis, which is associated with significant health risks due to overlapping factors like portal hypertension.
- - It introduces the concept of "hepatocardiorenal syndrome," highlighting the interconnections between liver, heart, and kidney functions, especially noting the role of cirrhotic cardiomyopathy in AKI cases.
- - The authors critique standard treatment methods for hepatorenal syndrome and propose a more tailored approach using point-of-care ultrasonography (POCUS) to better evaluate fluid status and cardiac health in affected patients.
Hepato-Cardio-Renal Syndrome.
Adv Kidney Dis Health
March 2024
Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL. Electronic address:
Hepatorenal syndrome has conventionally been regarded as a multisystem syndrome in which pathophysiologic pathways that link cirrhosis with impairment in kidney function are followed by dysfunction of several organs such as the heart. The advances in cardiac studies have helped diagnose more subtle cardiac abnormalities that would have otherwise remained unnoticed in a significant subset of patients with advanced liver disease and cirrhosis. Accumulating data suggests that in many instances, the cardiac dysfunction precedes and predicts development of kidney disease in such patients.
View Article and Find Full Text PDFHepatocardiorenal syndrome in liver cirrhosis: Recognition of a new entity?
World J Gastroenterol
January 2024
Donal O'Donoghue Renal Research Centre & Department of Renal Medicine, Northern Care Alliance National Health Service Foundation Trust, Salford M6 8HD, United Kingdom.
Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome (HRS), outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context. In the absence of established heart disease, cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease. It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.
View Article and Find Full Text PDFLiver steatosis, cardiac and renal fibrosis, and hypertension in overweight rats: Angiotensin-(3-4)-sensitive hepatocardiorenal syndrome.
Metabol Open
June 2022
National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Overweight/obesity is a growing pandemic that affects many organs and tissues. We have investigated whether a high-lipid diet provokes an imbalance between type 1 and type 2 angiotensin II (Ang II) receptors signaling, leading to liver alterations associated with cardiovascular and kidney disturbances. Chronic administration of a high-lipid diet can provoke hepatocardiorenal syndrome resulting from activation of the Ang II→type 1 receptor axis, which is entirely counteracted by Ang-(3-4), the allosteric enhancer of the Ang II→type 2 receptor pathway.
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