Rolando Ortega

Increased plasma levels of neuropeptide Y in hepatorenal syndrome.

BACKGROUND/AIMS To investigate the relationship between neuropeptide Y (NPY), a potent renal vasoconstrictor peptide released upon marked stimulations of sympathetic nervous system (SNS), and renal and circulatory function in cirrhosis. METHODS Plasma levels of NPY (radioimmunoassay) and norepinephrine and renal function parameters were determined in 17 healthy controls, nine patients with cirrhosis without ascites, and 37 patients with cirrhosis and ascites, of whom 12 had hepatorenal syndrome (HRS). RESULTS Patients with ascites showed circulating levels of NPY similar to those of patients without ascites and controls (73+/-4, +/-4 and 68+/-4 pmol/l, respectively; NS). However, patients with HRS had significantly increased levels of NPY with respect to the other groups (110+/-6 pmol/l; P<0.001). NPY levels correlated inversely with renal plasma flow and glomerular filtration rate and directly with norepinephrine. In patients with HRS (n=6) treatment with terlipressin and albumin was associated with a marked improvement in circulatory and renal function and marked suppression of NPY and norepinephrine levels. CONCLUSIONS Patients with HRS have increased levels of NPY which are related to circulatory dysfunction and SNS activation and may contribute to renal vasoconstriction.

Síndrome hepatorrenal: nuevos aspectos fisiopatológicos y terapéuticos ☆

1. Este trastorno es de origen funcional debido a que los rinones son normales en el examen histologico y la insuficiencia renal es reversible despues del trasplante hepatico. Junto con los cambios en la funcion renal, los pacientes con SHR tambien presentan notables alteraciones en la circulacion arterial sistemica y en la actividad de los sistemas vasoconstrictores endogenos, los cuales probablemente desempenan un papel muy relevante en el desarrollo de la insuficiencia renal. En anos recientes se han conseguido grandes avances en la patogenia, diagnostico y tratamiento de los pacientes con este sindrome. El objetivo del presente articulo es proporcionar una revision actualizada del SHR en la cirrosis.