![]() | Only 14 pages are availabe for public view |
Abstract Summary & Conclusions Hepatorenal syndrome is a unique form of acute kidney injury seen in patients with acute liver failure or chronic liver disease in absence of any other identifiable cause of renal failure. Despite of good pathophysiological understanding and better available therapeutic options for management of hepatorenal syndrome, it is still associated with significant morbidity and mortality. Liver transplantation forms the cornerstone for the management of hepatorenal syndrome. Several meta-analyses that evaluated vasoconstrictor therapies for HRS did not show any significant reduction in mortality without liver transplantation. N-acetyl-L-cysteine (NAC) is known as an antioxidant that acts directly and/or by increasing intracellular glutathione (GSH), especially on hepatic tissue. N-acetyl cysteine potentially has many clinical uses in the intensive care patient. It has been used to reduce the risk of hepatotoxicity associated with paracetamol, chloroform, carbon tetrachloride and potassium permanganate, nephrotoxicity caused by radiographic contrast agents, cardiotoxicity. When used to treat severe alcoholic hepatitis, i.v. acetylcysteine serves as an antioxidant and glutathione source. Improvement in patients with hepatorenal syndrome was also noted. |