Little information exists on the effects of transjugular intrahepatic
portosystemic shunts (
TIPS) in the management of cirrhotic patients with
hepatorenal syndrome (HRS). The current study was aimed to prospectively evaluate the effects of
TIPS on renal function and vasoactive systems in patients with type I HRS. Glomerular filtration rate (GFR) (
inulin clearance), renal plasma flow (RPF) (para-aminohippurate clearance), plasma
renin activity (PRA),
aldosterone (ALDO),
norepinephrine (NE), and
endothelin (ET) were determined in baseline conditions and at different time intervals after
TIPS in 7 patients with type I HRS.
TIPS induced a marked reduction of portal pressure gradient (PPG) (20 +/- 1 to 10 +/- 1 mm Hg; P < .05). Renal function improved in 6 of the 7 patients. Serum
creatinine and blood
urea nitrogen (BUN) decreased from 5 +/- 0.8 and 109 +/- 7 to 1.8 +/- 0.4 mg/dL and 56 +/- 11 mg/dL, respectively (P < .05 for both), and GFR and RPF increased from 9 +/- 4 and 103 +/- 33 to 27 +/- 7 mL/min and 233 +/- 40 mL/min, respectively (P < .05 for both), 30 days after
TIPS. These beneficial effects on renal function were associated with a significant (P < .05) reduction of PRA (18 +/- 5 to 3 +/- 1 ng/mL x h), ALDO (279 +/- 58 to 99 +/- 56 ng/dL), and NE (1,257 +/- 187 to 612 +/- 197 pg/mL). ET did not change significantly (28 +/- 8 to 27 +/- 11 pg/mL). Mean survival was 4.7 +/- 2 months (0.3-17 months). Three patients remained alive more than 3 months after
TIPS insertion. In conclusion,
TIPS improves renal function and reduces the activity of the
renin-
angiotensin and sympathetic nervous systems in cirrhotic patients with type I HRS. Nevertheless, the efficacy of
TIPS in the management of these patients should be confirmed in controlled investigations.