Renal Failure in Cirrhosis - Book Report/Review Example

Renal Failure in Cirrhosis The article chosen for review is “Renal Failure in Cirrhosis”. It is authored by Gines Pere and Schrier Robert and published in the New England Medicine Journal (Gines & Schrier 1279). The article talks about renal failure attributed to liver cirrhosis. The article explores the pathophysiology of renal failure and evaluation of patients with renal failure in cirrhosis. Further, the article elaborates on the possible differential diagnosis of this condition, before delving into the management of kidney failure in cirrhosis.

On the pathophysiology, the article notes that kidney failure in liver cirrhosis is related to circulatory function disturbances. There is a reduction in systemic vascular resistance (SVR) due to the dilation of arteries. This is triggered by portal hypertension. In the early stages of liver cirrhosis, cardiac output increases and compensates for the reduction in systemic vascular resistance. In later stages, the cardiac system is unable to compensate for the decreased SVR. The author’s note that bacterial translocation is another modality in which cirrhosis can lead to renal failure.

Bacterial translocation associated with cirrhosis elicits inflammation; therefore, leads to production of vasodilators, which decrease PVR. With this regards, antibiotics such as Norfloxacin can be used to prevent renal failure in cirrhosis (Gines & Schrier 1281). The article also elaborates on the evaluation of patients with kidney failure in cirrhosis. Emphasis is placed on the imperativeness of assessing renal and liver function. The article recommends that serum creatinine, electrolytes and protein levels should be measured daily.

The use of renal ultrasound is also advised, when ruling out urinary tract obstruction due to renal failure. A renal biopsy is imperative when there is a suspicion of parenchymal disease. Baseline liver function tests are recommended. A liver biopsy is indicated when the diagnosis of liver disease is not certain. Bacterial infections should be ruled out in patients presenting with worsening renal function (Gines & Schrier 1283). The article further elaborates in the differential diagnosis of kidney failure in cirrhosis.

These include the hepatorenal syndrome, acute tubular necrosis and drug toxicity. The initial care should entail supportive therapy including airway and circulatory support. The authors recommend third generation cephalosporin as a first line antibiotic. Hydrocortisone may be used in renal insufficiency. Vasoconstrictor drugs are noted to be effective in the management of hepatorenal syndrome. In this respect, vasopressin analogues are noted to be effective in 50% of patients (Gines & Schrier 1284).

Hemodialysis is recommended for those on the transplant waiting list. The prognosis of such patients is noted to be poor (Cameron 127). The authors address pertinent issues related to renal failure in cirrhosis patients. The article provides a concise account of the pathogenesis of renal failure in this subset of patients. The article does this in a clear and comprehensive manner which is apt for most health professionals. It then provides a stepwise and systematic manner in the evaluation of such patients.

It uses recent and up-to-date research and trials to come up with an efficient treatment and management plan. Overall, the authors unravel complexities surrounding the subject of renal failure in a precise manner. The information gathered from the article will assist health care professionals, especially those in the nephrology and liver unit. It will enlighten clinicians on the effective management plan for renal failure in cirrhosis. Kidney failure is a challenging complication when associated with liver cirrhosis.

The article has broadened my understanding of this pertinent issue. The knowledge that I have obtained from class with regards to renal failure have enabled me to grasp the content of this article. Works Cited Cameron, Stewart. Kidney Failure: The Facts. Oxford University Press, 1996. Print. Gines, Pere and Schrier Robert. “Renal Failure in Cirrhosis”. New England Journal of Medicine 363.13 (2009): 1279-1288.