76241
document
Hepatorenal syndrome . Studies of the effect of vascular volume and intraperitoneal pressure on renal and hepatic function . Eleven patients with well-documented hepatorenal syndrome were studied by measurement of blood volume , glomerular filtration rate , renal plasma flow , plasma aldosterone concentration , renin substrate concentration , and plasma renin activity . They were then given 750 ml of stored plasma , 750 ml of fresh frozen plasma , and then an infusion of angiotensin II , in random order on successive days . Infusion of fresh frozen plasma improved function more than did stored plasma and in addition returned a very low filtration fraction toward normal . Angiotensin II infusion increased filtration fraction , but decreased glomerular filtration rate , renal plasma flow , and urine flow sharply . Patients were then given a daily infusion of 1,000 ml of fresh frozen plasma for seven to 18 days to expand the blood volume to supranormal levels as assayed by serial measurement of blood volume . Plasma aldosterone levels decreased to a normal range , glomerular filtration rate and renal plasma flow both increased , and urinary excretion of sodium and potassium both returned toward normal . The effect of intraperitoneal pressure was then studied by measuring glomerular filtration rate , renal plasma flow , pressure in the vena cava , hepatic vein free flow , and hepatic vein wedged pressure before , during , and after paracentesis to reduce the intraperitoneal pressure from 30 to 40 cm H2O to 12 to 17 cm H2O . Venous pressures moved parallel to ascitic fluid pressures , and glomerular filtration rate , renal plasma flow , and urine flow all improved sharply ; then , as ascitic fluid continued to form , reducing vascular volume , urine flow , glomerular filtration rate , and renal plasma flow all decreased slowly . Six patients then underwent placement of a LeVeen shunt . Improvement in glomerular filtration rate and renal plasma flow and clinical condition was dramatic . During postoperative observation of up to two years , progressive improvement in hepatic function has occurred .
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Intervention_Pharmacological
750 ml of stored plasma
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Intervention_Pharmacological
750 ml of fresh frozen plasma
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Intervention_Pharmacological
infusion of angiotensin II
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Intervention_Pharmacological
Infusion of fresh frozen plasma
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Intervention_Pharmacological
Angiotensin II infusion
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Intervention_Pharmacological
1,000 ml of fresh frozen plasma
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Outcome_Physical
renal and hepatic function
76249
Outcome_Physical
blood volume
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Outcome_Physical
glomerular filtration rate
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Outcome_Physical
renal plasma flow
76252
Outcome_Physical
plasma aldosterone concentration
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Outcome_Physical
renin substrate concentration
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Outcome_Physical
plasma renin activity
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Outcome_Physical
filtration fraction
76256
Outcome_Physical
glomerular filtration rate
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Outcome_Physical
renal plasma flow
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Outcome_Physical
urine flow
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Outcome_Physical
Plasma aldosterone levels
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Outcome_Physical
glomerular filtration rate
76261
Outcome_Physical
renal plasma flow
76262
Outcome_Physical
urinary excretion of sodium and potassium
76263
Outcome_Physical
glomerular filtration rate
76264
Outcome_Physical
renal plasma flow
76265
Outcome_Physical
pressure in the vena cava
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Outcome_Physical
hepatic vein free flow
76267
Outcome_Physical
hepatic vein wedged pressure
76268
Outcome_Physical
Venous pressures
76269
Outcome_Physical
ascitic fluid pressures
76270
Outcome_Physical
glomerular filtration rate
76271
Outcome_Physical
renal plasma flow
76272
Outcome_Physical
urine flow
76273
Outcome_Physical
vascular volume
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Outcome_Physical
urine flow , glomerular filtration rate
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Outcome_Physical
renal plasma flow
76276
Outcome_Physical
glomerular filtration rate
76277
Outcome_Physical
renal plasma flow
76278
Outcome_Physical
clinical condition
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Outcome_Physical
hepatic function