Central Surgical Association| Volume 82, ISSUE 3, P337-341, September 1977

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Hepatorenal syndrome: Reversal by peritoneovenous shunt

  • William D. Fullen
    Reprint requests: William D. Fullen, M.D., Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267.
    From the Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio U.S.A.
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      Two patients with hepatorenal syndrome were treated by insertion of a peritoneovenous shunt. The renal deficit was corrected rapidly in both cases. A 62-year-old woman with a slow onset syndrome with urine output of 100 to 150 ml/day and urinary sodium excretion of 1 mEq/day responded with large volume urinary output and sodium excretion. She is alive with minimal ascites 18 months after shunt. A 53-year-old man with severe nutritional cirrhosis, alcoholic hepatitis, and eventual massive necrosis was treated for bleeding esophageal varices by portacaval shunt. Postoperative massive ascites progressed to acute hepatorenal syndrome. Insertion of a peritoneovenous shunt reversed the renal deficit. He eventually exsanguinated due to a hemorrhagic diathesis caused by massive hepatic necrosis.
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        • Ariyan S.
        • Sweeney J.
        • Kerstein M.D.
        The hepatorenal syndrome: Recovery after portacaval shunt.
        Ann Surg. 1975; 181: 847
        • Ayers C.R.
        Plasma renin activity and renin-substrate concentration in patients with liver disease.
        Circ Res. 1967; 20: 594
        • Barnardo D.E.
        • Baldus W.P.
        • Maher F.T.
        Effects of dopamine on renal function in patients with cirrhosis.
        Gastroenterology. 1970; 58: 524
        • Barnardo D.E.
        • Summerskill W.H.
        • Strong C.G.
        • et al.
        Renal function, renin activity, and endogenous vasoactive substances in cirrhosis.
        Am J Dig Dis. 1970; 15: 419
        • Berkowitz H.D.
        • Miller L.D.
        • Itskavoitz H.D.
        Liver disease, renal function, and the renin-angiotensin system.
        in: ed. 14. Surg Forum. 19. 1968: 391
        • Bradley S.E.
        Hepatorenal and glomerulotubular imbalance.
        N Engl J Med. 1973; 289: 1194
        • Eknoyan G.
        • Martinez-Moldonada M.
        • Yium J.J.
        • et al.
        Combined ascites-fluid and furosemide infusion in the management of ascites.
        N Engl J Med. 1970; 282: 713
        • Epstein M.
        • Berk D.P.
        • Hollemberg N.K.
        • et al.
        Renal failure in cirrhosis: The role of active vasoconstriction.
        Am J Med. 1970; 49: 175
        • Fischer J.E.
        • Baldessarini R.J.
        Renal changes in hepatic failure.
        Lancet. 1971; 2: 769
        • Goldstein H.
        • Boyle J.D.
        Spontaneous recovery from hepatorenal syndrome; report of four cases.
        N Engl J Med. 1965; 272: 895
        • Kew M.C.
        • Varma R.R.
        • Williams J.S.
        • et al.
        Renal and intrarenal blood flow in cirrhosis of the liver.
        Lancet. 1971; 2: 504
        • Koppel M.H.
        • Coburn J.W.
        • Mims M.M.
        • et al.
        Transplantation of cadaveric kidneys from patients with hepatorenal syndrome; evidence for the functional nature of renal failure in advanced liver disease.
        N Engl J Med. 1969; 280: 1367
        • Lancestremere R.G.
        • Davidson P.L.
        • Early L.E.
        • et al.
        Renal failure in Laennec's cirrhosis. II. Simultaneous determination of cardiac output and renal hemodynamics.
        J Clin Invest. 1922; 41: 1962
        • LeVeen H.H.
        • Christoudias G.
        • Luft R.
        • et al.
        Peritoneo-venous shunting for ascites.
        Ann Surg. 1974; 180: 580
        • Lieberman F.L.
        • Reynolds T.B.
        Plasma volume in cirrhosis of the liver; its relation to portal hypertension, ascites and renal failure.
        J Clin Invest. 1967; 46: 1297
        • McCloy R.M.
        • Baldus W.P.
        • Maher F.T.
        • et al.
        Effects on changing plasma volume; serum albumin concentration, and plasma osmolality on renal function in cirrhosis.
        Gastroenterology. 1967; 53: 229
        • McCloy R.M.
        • Baldus W.P.
        • Touxe W.N.
        • et al.
        Plasma volume and renal circulatory function in cirrhosis.
        Ann Intern Med. 1967; 66: 307
        • Reynolds T.B.
        • Lieberman F.L.
        • Redeker A.G.
        Functional renal failure with cirrhosis; the effect of plasma expansion therapy.
        Medicine. 1967; 46: 191
        • Schroeder E.T.
        • Rich R.H.
        • Simulyan H.
        Plasma renin level in hepatic cirrhosis; relation to functional renal failure.
        Am J Med. 1970; 49: 186
        • Schroeder E.T.
        • Numann P.J.
        • Chamberlain B.E.
        Functional renal failure in cirrhosis; recovery after portavacal shunt.
        Ann Intern Med. 1970; 72: 923
        • Schroeder E.T.
        • Sherar L.
        • Sancetta S.M.
        • et al.
        Renal failure in patients with cirrhosis of the liver. III. Evaluation of intrarenal blood flow by PAH extraction and response to angiotensin.
        Am J Med. 1967; 43: 887
        • Wapuick S.
        • Grosberg S.
        • Kinney M.
        • et al.
        LeVeen continuous peritoneal-jugular shunt.
        JAMA. 1977; 237: 131