Ariyan S, Sweeney T, Kerstein M D
Ann Surg. 1975 Jun;181(6):847-9. doi: 10.1097/00000658-197506000-00015.
Reversal of the morbid hepato-renal syndrome has been achieved in a cirrhotic patient with ascites following successful side-to-side portacaval shunt. The hepatorenal syndrome is defined as progressive unresponsive renal failure with previously normal kidneys in the presence of impaired hepatic function. Although the etiologic mechanism has not been defined, it is suggested the relationship of increased intrahepatic sinusoidal pressure on the thoracic duct and subsequent decreased lymph flow are interrelated to increased levels of aldosterone and manifested by (chylous) ascites. Laboratory and clinical evidence suggest that cirrhotics with ascites have remarkably high levels of aldosterone secretion via the rennin-angiotensin-adrenal cortex mechanism. This is the group that develops hepatorenal syndrome. Reduction of the intrahepatic pressure and decompression of the portal hypertension can be successfully achieved with a side-to-side shunt which should return the aldosterone-rennin-angiotensin axis to normal and subsequently reverse the hepatorenal syndrome.
一名肝硬化腹水患者在成功进行侧侧门腔分流术后，肝肾综合征得到逆转。肝肾综合征的定义为：在肝功能受损的情况下，既往肾功能正常的患者出现进行性无反应性肾衰竭。尽管病因机制尚未明确，但有人认为肝内窦压升高与胸导管的关系以及随后淋巴液流量减少与醛固酮水平升高相互关联，并表现为（乳糜性）腹水。实验室和临床证据表明，伴有腹水的肝硬化患者通过肾素 - 血管紧张素 - 肾上腺皮质机制分泌的醛固酮水平显著升高。正是这一群体易发生肝肾综合征。侧侧分流术可成功降低肝内压力并解除门静脉高压，这应能使醛固酮 - 肾素 - 血管紧张素轴恢复正常，从而逆转肝肾综合征。
