MRI to Assess the Effect of Terlipressin in Patients With Acute Hepatorenal Syndrome (HRS-AKI)
Condition: Hepato-Renal Syndrome; Portal Hypertension; Acute Kidney Injury; Liver Diseases; Liver Cirrhoses; Cirrhosis Cardiac; Cirrhosis
MeSH terms: Liver Diseases; Liver Cirrhosis; Hypertension, Portal; Hepatorenal Syndrome; Acute Kidney Injury; Syndrome; Fibrosis
Study type: Observational

Summary: 
      Heptorenal syndrome (HRS) is divided into two types. A non-acute kidney injury (NAKI-HRS),
      which is predominantly related to end-stage disease and a more acute kidney injury (HRS-AKI).
      HRS-AKI is potentially reversible and develops subsequent to aggravation of a systemic
      circulatory vasodilatation, that triggers renal vasoconstriction and deteriorates renal
      perfusion and function. The albumin and terlipressin response is evaluated clinically,
      routinely for a week and reduces mortality with 23% compared to no treatment. Only 40-50% of
      the patients with HRS-AKI respond to the treatment with terlipressin.

      The treatment of hepatorenal syndrome (HRS-AKI) is aimed at improving blood flow to the
      kidneys. Flow changes associated to development of HRS have only sparsely been studied and
      not previously by MR technique and no previous studies have evaluated changes in flow induced
      by terlipressin. It has been hypothesized that development of HRS is associated to a
      deterioration in heart function with development of cardiomyopathy, which together with renal
      vasoconstriction leads to renal failure. Simultaneous MR-assessments of cardiac function and
      flows (especially the renal flow) in HRS-AKI have not previously been performed.

      The aim of the project is to develop new, fast and non-invasive methods to evaluate
      hemodynamic changes and individual pharmacological terlipressin response in patients with
      acute hepatorenal syndrome (type HRS-AKI)

      We expect a higher increase in renal blood flow in terlipressin-responders compared to
      terlipressin-non-responders and non-responders will generally have a lower basic renal flow
      and a decreased cardiac output.

      Study design and patients The study design is experimental and includes 30 cirrhotic patients
      with HRS-AKI. Patients with HRS-AKI are MR scanned before and 17 minutes after their first
      dose of terlipressin. ECHO is performed before first dose of Terlipressin and is repeated
      after one of the first doses of terlipressin. Clinically efficacy is defined in accordance to
      international guidelines at day-7 and 90 days mortality is registered. The screening period
      and treatments follow international and national guidelines for acute renal failure in
      patients with cirrhosis.
    


Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        30 patients with cirrhosis and acute kidney injury who meet the criteria for HRS-AKI and
        needs terlipressin treatment.
      
Biospecimen description: 
      Standard clinical blood tests and pertinent bioactive substances is measured in blood and
      urine
    
Keywords: Terlipressin; Pharmacological respons; Magnetic Resonance Imaging; Hemodynamic assessments; Echocardiography; Hepatorenal syndrome - acute kidney injury