Bacterial infections in patients with cirrhosis
Chairs:  Prof Po-Ren Hsueh, Prof. Garcia-Tsao
• Welcome and introduction

• The new epidemiology of nosocomial bacterial infections in patients with cirrhosis: therapeutical implications (Javier Fernandez 20 min.)

• Bacterial translocation in cirrhosis: pathophysiology and clinical implications (20 min. Joseph Such)

• Bacterial infections: from bench to bedside (Ming-Hung Tsai, 20 min.) 

• Sepsis in patients with acute on chronic liver failure: new strategies for prevention and treatment (Shiv Sarin, 20 min)

• Pathophysiological basis of the use of albumin in the prevention of haemodynamic derangement due to bacterial infections in patients with cirrhosis (Paolo Angeli 20 min.)

• Discussion 20 min

09:00-12:00 EASL-IAC (International Club of Ascites) Joint Workshop: RENAL DYSFUNCTION IN

CIRRHOSIS IN THE ERA OF AKI: TOWARDS A NEW DEFINITION Chairs: M. Bernardi, Italy P.

Angeli. Italy

09:00 Introduction: Renal dysfunction in patients with cirrhosis: the long way traveled so

far by hepatologists V. Arroyo, Spain Critical points in the actual definitions of renal

dysfunction in cirrhosis

09:15 The definition of renal dysfunction in cirrhosis in the era of AKI ; is a 0.3 mg/dl

change enough in the setting of cirrhosis for diagnosis of AKI? M. Nadim, USA

09:30 The actual “grey zones” about the classification of patients with cirrhosis and

renal dysfunction. F. Wong, Canada

09:45 How to improve the differential diagnosis among HRS and ATN? C. Parihk, USA

10:00 Discussion S. Møller, Denmark C.L. Davis, USA Critical points in the treatment of

renal dysfunction in cirrhosis

10:15 How to optimize the pharmacological treatment for type 1 HRS A.J. Sanyal, USA

10:30 Coffee Break

11:00 What after the failure of vasoconstrictors and albumin in order to be effective and

to avoid futility? Extracorporeal renal and/or hepatic support, TIPS F. Salerno, Italy

11:15 Combined liver and kidney transplantation (CLKT): when is it indicated in patients

with cirrhosis and renal dysfunction? C.L. Davis, USA

11:30 Discussion M. Guevara, Spain M. Nadim, USA

11:45 Conclusions: Proposal of a new classification of renal dysfunction in patients with

cirrhosis: towards a consensus based on a multidisciplinary approach ? P. Ginès, Spain

IAC_Ascites_UPDATED PROGRAMME

1. Fluid-electrolyte disturbances in cirrhosis - Arun Sanyal, USA
2. Mechanisms and pathophysiology of hyponatremia in cirrhosis - Lupe Garcia, USA
3. Relevance of hyponatremia in acute and chronic liver failure – Paolo
Angeli, Italy           
4. Treatment of hyponatremia  -  S K Sarin (India)
5. Workshop – Presentation of a hyponatremia case

BIOMARKER DISCOVERY FOR RENAL DYSFUNCTION IN CIRRHOSIS

Sunday 31 October, 2010 (6.15-8.15 p.m.)

(Hotel Sheraton, Commowealth Room, Boston 2010)
Directors: Arun Sanyal M.D. and Paolo Angeli M.D.

Session 1 (hr. 6.15 p.m.-7.15 p.m.)

Chairmen: Vicente Arroyo M.D. , Florence Wong, M.D.

- Acute Kidney Injury Definitions: are they valid for early detection of renal dysfunction in patients with cirrhosis?(20 min) (Mitra Nadim, M.D.)
- Novel biomarkers of acute kidney injury in cirrhosis and their application in patients with cirrhosis (20 min) (Chirag Parikh, M.D.)

Discussion (20 min)
 
Session 2 (7.15 p.m. -8.15 p.m.)

Chairmen: Guadalupe Garcia-Tsao M.D. and Sam Lee M.D.

- Renal response to systemic infection: implications for biomarker development (20 min) (Richard Moreau, M.D.)
- Renal response to hypoperfusion: implications for biomarker development (20 min) (Rajiv Jalan M.D. )

Discussion  (20 min)

–
Proposed Faculty

Paolo Angeli M.D.
Vicente Arroyo M.D. ,
Florence Wong, M.D.
Guadalupe Garcia-Tsao, M.D.
Rajiv Jalan, M.D.
Sam Lee, M.D.
Richard Moreau, M.D.
Mitra Nadim, M.D.
Chirag Parikh, M.D.
Arun Sanyal

IAC-AASLD Joint Meeting in 2010

–
RATIONALE AND AIMS OF THE AASLD-IAC JOINT MEETING
BIOMARKER DISCOVERY FOR RENAL DYSFUNCTION IN CIRRHOSIS
Renal complications are common in cirrhosis, especially in patients with refractory ascites, and they can negatively impact the patients’ survival. The International Ascites Club has set out clear diagnostic criteria for both acute and chronic forms of HRS. Nevertheless, IAC has not delineated guidelines for the diagnosis of other forms of renal impairment in cirrhosis, be they acute or chronic. Well-accepted definitions and staging systems for chronic kidney disease (CKD) and acute kidney disease (AKI) exist but they have been not applied up to now in patients with chronic liver disease. In addition either IAC criteria as well as the more recent definitions of CKD and AKI are based on serum creatinine. Serum creatinine is notoriously inaccurate in the diagnosis of renal dysfunction in cirrhosis. Patients with cirrhosis often have low serum creatinine levels, due to reduced production of creatinine from creatine in the liver and significant muscle wasting. Thus, serum creatinine in patients with cirrhosis can still be within the normal range despite significant renal dysfunction. The use of creatinine clearance in cirrhosis to assess renal function is also unreliable because of the falsely low serum creatinine in these patients, coupled with a relatively increased renal tubular creatinine secretion compared to filtered creatinine. Formulae such as the Cockcroft–Gault and Modification of Diet in Renal Disease (MDRD), which are based on the serum creatinine concentrations, will also overestimate the GFR in patients with cirrhosis. Thus, other biological markers should be introduced and validated in patients with advanced liver disease. Working together, nephrologists, hepatologists, intensivists can discover and propose novel biomarkers taking into account the complexity of the pathophysiology of renal dysfunction in patients with chronic liver disease. Although there is considerable evidence that renal failure in patients with cirrhosis is primarily related to disturbances in circulatory function, several other factors can be involved such as etiologic factors underlying the liver disease, bacterial infections, cholestasis, NSAIDs or other drugs, co-morbidities. As a consequence the spectrum of renal histopathological changes in cirrhosis is extensive and individuals may have coincident glomerular and tubulointerstitial, acute and chronic lesions. The mulitidisciplinary approach to renal dysfunction in cirrhosis, on which the workshop is focused, let it possible to discuss in depth this topic. The proposed speakers, either hepatologists or nephrologists, are well known experts of renal dysfunction in cirrhosis.

Paolo Angeli, M.D.

Rationale of the MEETING-IAC-AASLD

Chairs: Mauro Bernardi (Italy) and Samuel Lee (Canada) (presentations 15min each, followed by open discussion from floor 10-15min)

1. 0900-0905h: Introduction – Mauro Bernardi

2. 0905-0925h: Gut microflora in cirrhosis – Jose Such, Spain

3. 0925-0950: Sepsis and SIRS – JL Vincent, Belgium

4. 0950-1015: Gut bacterial translocation: mechanisms and consequences – Rainer Wiest, Germany

1015-1030: coffee break

5. 1030-1100: Infections and pathogenesis of hepatorenal syndrome: Soeren Moeller, Denmark

6. 1100-1155: Spontaneous bacterial peritonitis management consensus building:

A) antibiotic treatment choices – discussion led by Paolo Angeli, Italy.

B) Albumin infusion yes or no? – discussion led by Monica Guevara, Spain.

C) Primary prophylaxis treatment – discussion led by Shiv Sarin, India (Each discussion leader will summarize the state-of-the art and propose recommendations in 5-7min and this will be followed by discussion from the floor)

7. 1155-1200: Summary and conclusion: Sam Lee

“COMPLICATIONS OF CHRONIC LIVER FAILURE: NEW PARADIGMS”

Informations at www.congrex.no/ica2009

For informations see http://www.aleh-svg2008.com/

September 05-07 2008 Atlanta, Georgia Co-sponsored by AASLD and EASL

Course directors: G. Garcia-Tsao P. Gines A. Cardenas

Read more here.