The article chosen for review is 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 the 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).
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.
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