How is transjugular intrahepatic portosystemic stent shunt used in the treatment of AKI HRS?
TIPS is a prosthesis that can effectively reduce portal pressure. In addition, it returns a significant part of the splanchnic vascular volume into the systemic circulation, decreasing the activity of various vasoconstrictor systems.
The use of TIPS in the management of AKI-HRS has been shown to lead to an improvement, but not normalization, of GFR. The use of vasoconstrictor therapy followed by TIPS insertion in AKI-HRS patients was able to normalize kidney function over the course of 12 months with an overall survival rate of 50%.
The use of TIPS as a treatment for AKI-HRS is falling out of favor, as patients with AKI-HRS have advanced liver disease and there are valid concerns about precipitating liver failure if TIPS is inserted.
Therefore TIPS is of limited use in AKI-HRS and can only be recommended in a very select group of patients with AKI-HRS, such as those with significant portal hypertension but minimal liver dysfunction.
