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Advances in Liver Failure and Management

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Critical Care Pediatric Nephrology and Dialysis: A Practical Handbook

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Abstract

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) in children are rare but catastrophic clinical conditions with a high mortality and morbidity. Massive hepatocyte necrosis leads to profound impairment in synthetic, excretory, and detoxifying ability of the liver and leads to coagulopathy, jaundice, and encephalopathy. Circulating inflammatory mediators and toxins lead to multi-organ failure and death. As there are yet no treatment options for reversing or halting hepatocellular necrosis, current therapies focus more on supporting the failing organs, while the liver either spontaneously regenerates or child undergoes a liver transplant. Continuous renal replacement therapy (CRRT) forms one of such essential pillars of support implemented to successfully manage a critically ill child with ALF or ACLF. CRRT is either used alone or in combination of other blood purification modalities to attenuate the deleterious effects of a failing liver in the host. This chapter discusses the pathophysiology of liver failure, indications, benefits, and challenges of CRRT in pediatric liver failure.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Section of Pediatric Critical Care, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Moreshwar Desai

  2. Liver Intensive Care Unit, Texas Children’s Hospital, Houston, TX, USA

    Moreshwar Desai

  3. Department of Pediatrics, Sections of Critical Care and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Ayse Akcan-Arikan

  4. Extracorporeal Liver Support, Texas Children’s Hospital, Houston, TX, USA

    Ayse Akcan-Arikan

  5. Critical Care Nephrology, Texas Children’s Hospital, Houston, TX, USA

    Ayse Akcan-Arikan

Authors
  1. Moreshwar Desai
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  2. Ayse Akcan-Arikan
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Corresponding author

Correspondence to Ayse Akcan-Arikan .

Editor information

Editors and Affiliations

  1. Kidney & Urology Institute, Medanta, The Medicity Kidney & Urology Institute, Gurugram, Haryana, India

    Sidharth Kumar Sethi

  2. Department of Nephrology, Cleveland Clinic Akron General Medical center and Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

  3. Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Mignon McCulloch

  4. Pediatric Nephrology, Children’s Hospital of Richmond at the Virginia Commonwealth University, Richmond, VA, USA

    Timothy E. Bunchman

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Desai, M., Akcan-Arikan, A. (2019). Advances in Liver Failure and Management. In: Sethi, S., Raina, R., McCulloch, M., Bunchman, T. (eds) Critical Care Pediatric Nephrology and Dialysis: A Practical Handbook. Springer, Singapore. https://doi.org/10.1007/978-981-13-2276-1_23

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  • DOI: https://doi.org/10.1007/978-981-13-2276-1_23

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2275-4

  • Online ISBN: 978-981-13-2276-1

  • eBook Packages: MedicineMedicine (R0)

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