Abstract

Case Report

Hepato-Pulmonary syndrome and Porto-Pulmonary Hypertension: Rare combination cause of Hypoxemia in patient with end-stage renal failure on Hemodialysis and hepatitis C Induced Decompensated Cirrhosis

Awad Magbri*, Mariam El-Magbri and Eussera El-Magbri

Published: 18 December, 2017 | Volume 1 - Issue 1 | Pages: 008-012

The case is that of 83 year-old African American man with hypertension, hepatitis C induced decompensated cirrhosis with ascites, end-stage renal disease (ESRD) on hemodialysis, fluid overload with peripheral edema and chronic hypotension. The patient was referred to the dialysis access center of Pittsburgh, PA for evaluation of his prolonged bleeding from the left upper arm brachial-basilic arterial-venous fistula (BBAVF).

Read Full Article HTML DOI: 10.29328/journal.avm.1001002 Cite this Article Read Full Article PDF

Keywords:

Hepato-pulmonary syndrome; Porto-pulmonary hypertension; Hypoxemia; Cirrhosis; End-stage renal disease; Contrast echocardiography; Pulmonary arterial pressure; Left ventricular end-diastolic volume; Pulmonary hypertension

References

  1. Pham DM, Subramanian R, Parekh S. Coexisting hepatopulmonary syndrome and portopulmonary hypertension. J Clin Gastroenterol. 2010; 44: 135-140. Ref.: https://goo.gl/QegECL
  2. Toya S, Schraufnagel DE. Hepatopulomonary syndrome and pulmonary hypertension in the same patient: a pathophysiological paradox and therapeutic dilemma. Respiratory Medicine Extra. 2006; 2: 23-26. Ref.: https://goo.gl/JGQLKr
  3. Feltracco P, Serra E, Brezzi M, Milevoj M, Rizzi S, et al. Hemodynamic profile of portopulmonary hypertension. Transplant Proceedings. 2009; 41: 1235-1239. Ref.: https://goo.gl/yexq9K
  4. Whyre MK, Hughes JM, Peters AM, Ussov W, ShetalPatel, et al. Analysis of intrapulmonary right to left shunt in the hepatopulmonary syndrome. J Hepatol. 1998; 29: 85-93. Ref.: https://goo.gl/8tYDB5
  5. Badesch DB, Champion HC, Sanchez MA, Hoeperet MM, Loyd JE, et al. Dignosis and assessment of pulmonary arterial hypertension. J AM Coll Cardiol. 2009; 54: S55-S66. Ref.: https://goo.gl/j9YLGx
  6. Pabst S, Hammerstringl C, Hundt F, Gerhardt T, Grohé C, et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study. PLoS One. 2012; 7: 35310. Ref.: https://goo.gl/bjjjhG
  7. Yigla M, Fruchter O, Aharonson D, Noa Y, Shimon A.Reisner, et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int. 2009; 75: 969-975. Ref.: https://goo.gl/YEmGP8
  8. Ramasubbu K, Deswal A, Herejurgen C, Aguilar D, Frost AE. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med. 2010; 3: 279-286. Ref.: https://goo.gl/885Eag
  9. Bozbas SS, Akcay S, Altin C, Bozbas H, Karacaglar E, et al. Pulmonary hypertension in patients with end-stage renal disease undergoing renal transplantation. Transplant proc. 2009; 41: 2753-2756. Ref.: https://goo.gl/YG15U1
  10. Etemadi J, Zolfaghari H, Firoozi R, Ardalan MR, Toufan M, et al. Unexplained pulmonary hypertension in peritoneal dialysis and hemodialysis patients. Rev Rort Pneumol. 2012; 18: 10-14. Ref.: https://goo.gl/dSfm9A
  11. Fabbian F, Cantelli S, Molino C, Pala M, Longhini C, et al. Pulmonary hypertension in dialysis patients: a crosssectional Italian study. Int J Nephrol. 2010; 11: 463-475. Ref.: https://goo.gl/AqcsAu
  12. Zlotnick DM, Axelrod DA, Chobanian MC, Scott Friedman, Brown J, et al. Noninvasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transplant. 2010; 25: 3090-3096. Ref.: https://goo.gl/PXpv5p
  13. Kumbar L, Fein PA, Rafiq MA, Borawski C, Chattopadhyay J, et al. Pulmonary hypertension in peritoneal dialysis patients. Adv Perit Dial. 2007; 23: 127-131. Ref.: https://goo.gl/rgLpN3
  14. Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial transplant. 2012; 27: 3908-3914. Ref.: https://goo.gl/6XNkoT
  15. Kiykim AA, Horoz M, Ozcan T, Yildiz I, sari S, et al. Pulmonar hypertension in hemodialysis patients without arteriovenouws fistula: the effect of dialyzer composition. Ren Fail. 2010; 32: 1148-1152. Ref.: https://goo.gl/LBh6sy
  16. Evans AM, Hardie DG, Peers C, Mahmoud A. Hypoxic pulmonary vasoconstriction: mechanism of oxygen-sensing. Curr Opin Anaesthesiol. 2011; 24: 13-20. Ref.: https://goo.gl/jiHBPQ
  17. Sakao S, Tatsumi K, Voelkel NF. Reversible of irreversible remodeling in pulmonary arterial hypertension. Am J Respir Cell Mol Biol. 2010; 43: 629-634. Ref.: https://goo.gl/5e121z
  18. Halpern SC, Taichman DB. Misclassification of pulmonary hypertension due to reliance on pulmonary capillary wedge pressure rather than left ventricular end-diastolic pressure. Chest. 2009; 136: 37-43. Ref.: https://goo.gl/KTDtnJ
  19. Issa N, Krowka MJ, Griffin MD, Hickson LJ, Stegall MD, et al. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation. 2008; 86: 1384-1388. Ref.: https://goo.gl/vdXAyz
  20. Abdelwhab S, Elshinnawy S. Pulmonary hypertension in chronic renal failure patients. Am J Nephrol. 2008; 28: 990-997. Ref.: https://goo.gl/1DC8HT
  21. Yigla M, Nakhoul F, Sabag A, Tov N, Gorevich B, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest. 2003; 123: 1577-1582. Ref.: https://goo.gl/9dzV6a
  22. Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, et al. Pulmonary hypertension in patients with chronic renal failure. Respiration. 2007; 74: 503-510. Ref.: https://goo.gl/k27LBh
  23. Abassi Z, Nakhoul F, Khankin E, Reisner SA, Yigla M. Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula : pathogenesis and therapeutic prospective. Curr Opin Nephrol Hypertens. 2006; 15: 353-360. Ref.: https://goo.gl/ygMuL7
  24. Sakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol. 2011; 6: 995-1000. Ref.: https://goo.gl/p5i3Nb
  25. Zoccali C, Mallamaci F, Tripepi G. Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients. J AM Soc Nephrol. 2002; 3: 729-733. Ref.: https://goo.gl/3VLjqU
  26. Sica AL, Greenberg HE, Ruggiero DA, Scharf SM. Chronic intermittent hypoxia: a model of sympathetic activation in the rat. Respir Physiol. 2000; 121: 173-184. Ref.: https://goo.gl/YLvv1q
  27. Barcelo A, de la Pena M, Ayllon O, Vega-Agapito MV, Piérola J, et al. Increased plasma levels of asymmetric dimethylarginine and soluble CD40 ligand in patients with sleep apnea. Respiration. 2009; 77: 85-90. Ref.: https://goo.gl/2ZrwkF
  28. Grassi G, Seravalle G, Ghiadoni L, Giovanni T, Rosa MB, et al. Sympathetic nerve traffic and asymmetric dimethylarginine in chronic kidney disease. Clin J Am Soc Nephrol. 2011; 6: 2620-2627. Ref.: https://goo.gl/BjivP5
  29. Mallamaci F, Tripepi G, Maas R, Malatino L, Boger R, et al. Analysis of the relationship between norepinephrine and asymmetric dimethylarginine levels among patients with end-stage renal disease. J Am Soc Nephrol. 2004; 15: 435-441. Ref.: https://goo.gl/9PpjHh
  30. Tripepi G, Mattace Raso F, Sijbrands E, Mohamed SS, Renke Maas, et al. Inflammation and asymmetric dimethyl arginine for predicting death and cardiovascular events in ESRD patients. Clin J Am Soc Nephrol. 2011; 6: 1714-1721. Ref.: https://goo.gl/UvfN7M
  31. Yigla M, Abassi Z, Reisner SA, Nakhoul F. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial. 2006; 19: 353-357. Ref.: https://goo.gl/DNKpHs
  32. Giaid A. Nitric oxide and endothelin-1 in pulmonary hypertension. Chest. 1998; 114: 208-212. Ref.: https://goo.gl/8XaUqn
  33. Macedo IG, Lopes EP. Hepatopulmonary syndrome. San Paulo Medical Journal. 2009; 127: 223-230. Ref.: https://goo.gl/15gzrL
  34. Hopkins WE, Waggoner AD, Barzilai B. Frequency and significance of intrapulmonary right to left shunting in end stage liver disease. Am J Cardiol. 1992; 70: 516-519. Ref.: https://goo.gl/vybP1A
  35. Hoeper MM, Krowka MJ, Strassburg CP. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet. 2004; 363: 1461-1468. Ref.: https://goo.gl/uqiZAK
  36. Austin MJ, Mcougall NI, Wendon J, Elizabeth S, Knisely AS, et al. Safety and efficacy of combined use of sildenafil, bosentan and IIoprost before and after liver transplantation in severe portopulmonary hypertension. 2008; 14: 287-291. Ref.: https://goo.gl/ogoZkJ

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