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Alexander L Gerbes - One of the best experts on this subject based on the ideXlab platform.

  • HEPAT 01429 Medical treatment of ascites in cirrhosis
    2015
    Co-Authors: Alexander L Gerbes
    Abstract:

    Medical treatment of cirrhotic ascites is essentially supportive, dictated by the patient's discomfort, impaired car-diovascular o respiratory function and potential for infection. Treatment of'simple ' ascites (moderate fluid accumula-tion, serum albumin> 3.5 g/dl, serum creatinine < 1.5 mg/di, no electrolyte disturbance) is implemented sequentially. Only 10 % of patients respond to dietary sodium restriction and bed rest; most require pharmacotherapy consisting of spironolactone, which increases the proportion of responding patients to 65 % and loop diuretics, which may pro-duce clinical improvement i an additional 20 % (85 % in all); in the remaining 15 % of refractory patients, use of novel adjunctive therapies may be attempted. Patients with tense ascites, impaired renal function and electrolyte distur-bances merit special consideration before diuretics are introduced. Spironolactone has long been a standard for the treatment of cirrhotic ascites because it directly antagonizes aldosterone. The loop diuretic most frequently added to spironolactone has been furosemide. However, there is preliminary evidence that torasemide may be more effective in some patients. Other investigational agents that may play a role in treatment of patients resistant to conventional drugs include Ornipressin (a vasopressin analogue) and atrial natriuretic factor

  • long term therapy and retreatment of hepatorenal syndrome type 1 with Ornipressin and dopamine
    Hepatology, 1999
    Co-Authors: M Veit D Gulberg, M Bilzer, Alexander L Gerbes
    Abstract:

    Peripheral vasodilation is considered an important factor in the pathophysiology of the hepatorenal syndrome (HRS). Therefore, the aim of this study was to evaluate the therapeutic potential of the vasoconstrictor Ornipressin plus dopamine in the treatment of the most severe form of HRS, namely HRS type 1. Seven cirrhotic patients (creatinine clearance 15 ± 1 mL/min, UNaV 7 ± 2 mmol/24 h) with HRS type 1 were included in the study after normalization of central venous pressure with intravenous albumin and low-dose dopamine had failed to prevent further deterioration of renal function. Ornipressin was given continuously (intravenous 6 IU/h) in combination with dopamine (2-3 μg/kg/min) until creatinine clearance had increased to above 40 mL/min or adverse events prevented further treatment. HRS was reverted in 4 of 7 patients after 5 to 27 days (creatinine clearance 51 ± 4 mL/min, UNaV 47 ± 11 mmol/24 h) of treatment. Withdrawal was necessary in 1 patient after 15 days because of intestinal ischemia. Treatment failure was observed in 2 of 7 patients (creatinine clearance 19 ± 10 mL/min, UNaV 8 ± 3 mmol/24 h). Two of 4 responders had recidivant HRS 2 and 8 months after initial therapy, respectively. HRS in 1 of these patients was reverted with 18 days of Ornipressin retreatment. The other patient had to be withdrawn from Ornipressin after 2 hours because of ventricular tachyarrhythmia. Altogether, 3 of 7 patients survived HRS type 1, 1 after successful Ornipressin therapy and liver transplantation, 1 with 2 successful courses of Ornipressin, and 1 with liver transplantation after Ornipressin treatment had failed. Thus, Ornipressin plus dopamine can be a useful therapeutic option in patients with HRS type 1, especially as bridge to liver transplantation.

  • successful conservative therapy of hepatorenal syndrome with vasopressin 1 receptor antagonist Ornipressin
    Zeitschrift Fur Gastroenterologie, 1998
    Co-Authors: Veit Gulberg, P Luppa, J Pauletzki, Gustav Paumgartner, Alexander L Gerbes
    Abstract:

    A 47-year-old male patient with alcoholic cirrhosis Child-Pugh grade C was admitted to our center for evaluation of liver transplantation. Serum creatinine had increased from 1.6 to 4.3 mg/100 ml within the previous two weeks, creatinine clearance was 12 ml/min, and urinary sodium 12 mmol/24 h. The diagnosis of HRS type I was established. Diuretic treatment was discontinued. Following albumin infusion, central venous pressure was increased to above 10 cm H2O and dopamine (2 micrograms/kg/min) infusion was started. However, renal function did not improve. An i.v. infusion of Ornipressin (POR8, Sandoz; 6 IU/h) was started and dopamine infusion continued. During a four-hour interval, urinary volume and sodium excretion doubled. Therefore treatment was continued for three weeks. After 22 days, renal function had normalized (creatinine 1.2 mg/100 ml, creatinine clearance 65 ml/min, urinary sodium 62 mmol/24 h) and diuretic therapy was resumed. No adverse effects were observed. Ornipressin/dopamine infusion was discontinued and renal function remained normal. Three weeks later, the patient underwent liver transplantation with normal renal function. Ornipressin infusion had no effect on circulating endothelin, but decreased the activation of the renin-aldosterone system and of the sympathetic activity. So far, no noninvasive therapy of hepatorenal syndrome has been established. This is the first report of successful medical treatment of HRS type I with a three-week infusion of the vasopressin-l-receptor agonist Ornipressin.

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid, Bruno Schneeweiss, Anton N Laggner, Georg Grimm, Alexander L Gerbes
    Abstract:

    In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (-27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% (P less than 0.05). A decline of the elevated plasma levels of noradrenaline (2.08-1.13 ng/mL; P less than 0.01) and renin activity (27.6-14.2 ng.mL-1.h-1; P less than 0.01) was achieved. The plasma concentration of the atrial natriuretic factor increased in most of the patients, but slightly decreased in 3 patients. The decrease of renal vascular resistance and the increase of renal blood flow and of the renal fraction of cardiac output play a key role in the beneficial effect of Ornipressin on renal failure. These changes develop by an increase in mean arterial pressure, the reduction of the sympathetic activity, and probably of an extenuation of the splanchnic vasodilation. A significant contribution of atrial natriuretic factor is less likely. The present findings implicate that treatment with Ornipressin represents an alternative approach to the management of functional renal failure in advanced liver cirrhosis.

Rainer Schmid - One of the best experts on this subject based on the ideXlab platform.

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis effects on renal hemodynamics and atrial natriuretic factor
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid
    Abstract:

    Abstract In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (−27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% ( P P −1 · h −1 ; P

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid, Bruno Schneeweiss, Anton N Laggner, Georg Grimm, Alexander L Gerbes
    Abstract:

    In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (-27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% (P less than 0.05). A decline of the elevated plasma levels of noradrenaline (2.08-1.13 ng/mL; P less than 0.01) and renin activity (27.6-14.2 ng.mL-1.h-1; P less than 0.01) was achieved. The plasma concentration of the atrial natriuretic factor increased in most of the patients, but slightly decreased in 3 patients. The decrease of renal vascular resistance and the increase of renal blood flow and of the renal fraction of cardiac output play a key role in the beneficial effect of Ornipressin on renal failure. These changes develop by an increase in mean arterial pressure, the reduction of the sympathetic activity, and probably of an extenuation of the splanchnic vasodilation. A significant contribution of atrial natriuretic factor is less likely. The present findings implicate that treatment with Ornipressin represents an alternative approach to the management of functional renal failure in advanced liver cirrhosis.

Vicente Arroyo - One of the best experts on this subject based on the ideXlab platform.

  • terlipressin plus albumin infusion an effective and safe therapy of hepatorenal syndrome
    Journal of Hepatology, 2000
    Co-Authors: Juan Uriz, Pere Ginès, Wladimiro Jiménez, Andrés Cárdenas, Pau Sort, J Salmeron, Ramon Bataller, A Mas, M Navasa, Vicente Arroyo
    Abstract:

    Abstract Background/Aim: Ornipressin, a vasopressin analog with potent splanchnic vasoconstrictor action, has been shown to reverse hepatorenal syndrome. However, its usefulness in clinical practice is limited by frequent ischemic complications. The aim of this study was to assess the efficacy of terlipressin, an analog of vasopressin with a low profile of side effects, plus albumin in this condition. Methods: Nine consecutive patients with cirrhosis and hepatorenal syndrome were included in a pilot study of terlipressin (0.5–2 mg/4 h iv) therapy associated with iv albumin. Results: Treatment (9 days, range 5–15) was associated with a marked reduction of serum creatinine (3.9±0.7 to 1.3±0.1 mg/dl, p p p Conclusions: Terlipressin associated with albumin appears to be a safe and effective treatment of hepatorenal syndrome.

  • reversibility of hepatorenal syndrome by prolonged administration of Ornipressin and plasma volume expansion
    Hepatology, 1998
    Co-Authors: Monica Guevara, Wladimiro Jiménez, Vicente Arroyo, Pau Sort, M Pere D Gines, Gloria Fernandezesparrach, Joan M Salmeron, J Rodes
    Abstract:

    Hepatorenal syndrome is caused by a marked vasoconstriction of the renal circulation. It is suggested that the renal vasoconstriction is related to an overactivity of vasoconstrictor systems secondary to a vasodilation of the arterial circulation that causes a reduction in effective arterial blood volume. To test this hypothesis, 16 cirrhotic patients with hepatorenal syndrome were treated with a combination of Ornipressin, a potent vasoconstrictor agent, and plasma volume expansion with albumin to improve effective arterial blood volume. The combined treatment was administered either for 3 or 15 days (8 patients each), and the effects on renal function, vasoactive systems, and systemic hemodynamics were assessed. The 3-day treatment with Ornipressin and albumin was associated with a normalization of the overactivity of renin-angiotensin and sympathetic nervous systems, a marked increase in atrial-natriuretic peptide levels, and only a slight improvement in renal function. However, when Ornipressin and albumin were administered for 15 days, a remarkable improvement in renal function was observed, with normalization of serum-creatinine concentration, a marked increase in renal plasma flow and glomerular filtration rate, and a persistent suppression in the activity of vasoconstrictor systems. However, 3 of 8 patients on 15-day therapy treatment had to be discontinued because of ischemic complications. In conclusion, the decrease in effective arterial blood volume and the activation of vasoconstrictor systems play a crucial role in the pathogenesis of hepatorenal syndrome. Although the prolonged administration of Ornipressin combined with plasma volume expansion reverses hepatorenal syndrome, this treatment should be used with great caution in clinical practice because of the risk of ischemic complications.

  • renal and neurohormonal changes following simultaneous administration of systemic vasoconstrictors and dopamine or prostacyclin in cirrhotic patients with hepatorenal syndrome
    Journal of Hepatology, 1996
    Co-Authors: Joan Salo, Pere Ginès, Wladimiro Jiménez, Ramon Bataller, Monica Guevara, Gloria Fernandezesparrach, Angels Gines, J Quer, R Planas, Vicente Arroyo
    Abstract:

    Abstract Background/Aims: Intravenous Ornipressin in cirrhotic patients with hepatorenal syndrome causes marked improvement of systemic hemodynamics and suppression of plasma renin and norepinephrine but only moderate improvement of renal function. This study was designed to investigate whether these beneficial effects could be enhanced by the simultaneous administration of dopamine. The renal effects of the i.v. infusion of norepinephrine plus prostacyclin in patients with hepatorenal syndrome were also assessed. Methods: Renal plasma flow, glomerula filtration rate, free water clearance, sodium excretion and the plasma levels of renin and norepinephrine were measured in baseline conditions and during the administration of Ornipressin (6 IU/h) and Ornipressin (6 IU/h) plus dopamine (2 μg/kg·min) in nine patients with hepatorenal syndrome. Five additional patients with hepatorenal syndrome were studied prior to and following the administration of norepinephrine (0.45±0.1 μg/kg·min) and norepinephrine (0.85±0.2 μg/kg·min) plus prostacyclin (5 ng/kg·min). Results: Despite a significant increase in arterial pressure and marked suppression of plasma renin activity during Ornipressin and Ornipressin plus dopamine administration, no significant improvement in renal function was observed. Norepinephrine and norepinephrine plus prostacyclin also failed to increase renal perfusion and glomerular filtration rate. Conclusions: The combined administration of systemic vasoconstrictors (Ornipressin or norepinephrine) and vasodilators (dopamine or prostacyclin), at the doses used in the current study and for a short period of time, does not improve renal function in cirrhotic patients with hepatorenal syndrome. The current study does not confirm a potential role for Ornipressin in the treatment of hepatorenal syndrome.

Kurt Lenz - One of the best experts on this subject based on the ideXlab platform.

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis effects on renal hemodynamics and atrial natriuretic factor
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid
    Abstract:

    Abstract In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (−27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% ( P P −1 · h −1 ; P

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid, Bruno Schneeweiss, Anton N Laggner, Georg Grimm, Alexander L Gerbes
    Abstract:

    In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (-27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% (P less than 0.05). A decline of the elevated plasma levels of noradrenaline (2.08-1.13 ng/mL; P less than 0.01) and renin activity (27.6-14.2 ng.mL-1.h-1; P less than 0.01) was achieved. The plasma concentration of the atrial natriuretic factor increased in most of the patients, but slightly decreased in 3 patients. The decrease of renal vascular resistance and the increase of renal blood flow and of the renal fraction of cardiac output play a key role in the beneficial effect of Ornipressin on renal failure. These changes develop by an increase in mean arterial pressure, the reduction of the sympathetic activity, and probably of an extenuation of the splanchnic vasodilation. A significant contribution of atrial natriuretic factor is less likely. The present findings implicate that treatment with Ornipressin represents an alternative approach to the management of functional renal failure in advanced liver cirrhosis.

Heide Hortnagl - One of the best experts on this subject based on the ideXlab platform.

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis effects on renal hemodynamics and atrial natriuretic factor
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid
    Abstract:

    Abstract In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (−27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% ( P P −1 · h −1 ; P

  • Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis
    Gastroenterology, 1991
    Co-Authors: Kurt Lenz, Heide Hortnagl, Wilfred Druml, Harald Reither, Rainer Schmid, Bruno Schneeweiss, Anton N Laggner, Georg Grimm, Alexander L Gerbes
    Abstract:

    In 11 patients with decompensated cirrhosis and deteriorating renal function, the effect of the vasoconstrictor substance 8-ornithin vasopressin (Ornipressin; POR 8; Sandoz, Basel, Switzerland) on renal function, hemodynamic parameters, and humoral mediators was studied. Ornipressin was infused at a dose of 6 IU/h over a period of 4 hours. During Ornipressin infusion an improvement of renal function was achieved as indicated by significant increases in inulin clearance (+65%), paraaminohippuric acid clearance (+49%), urine volume (+45%), sodium excretion (+259%), and fractional elimination of sodium (+130%). The hyperdynamic circulation was reversed to a nearly normal circulatory state. The increase in systemic vascular resistance (+60%) coincided with a decrease of a previously elevated renal vascular resistance (-27%) and increase in renal blood flow (+44%). The renal fraction of the cardiac output increased from 2.3% to 4.7% (P less than 0.05). A decline of the elevated plasma levels of noradrenaline (2.08-1.13 ng/mL; P less than 0.01) and renin activity (27.6-14.2 ng.mL-1.h-1; P less than 0.01) was achieved. The plasma concentration of the atrial natriuretic factor increased in most of the patients, but slightly decreased in 3 patients. The decrease of renal vascular resistance and the increase of renal blood flow and of the renal fraction of cardiac output play a key role in the beneficial effect of Ornipressin on renal failure. These changes develop by an increase in mean arterial pressure, the reduction of the sympathetic activity, and probably of an extenuation of the splanchnic vasodilation. A significant contribution of atrial natriuretic factor is less likely. The present findings implicate that treatment with Ornipressin represents an alternative approach to the management of functional renal failure in advanced liver cirrhosis.