Barada Kassem
Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 110 72020, Beirut, Lebanon.
Curr Opin Pharmacol. 2004 Apr;4(2):189-97. doi: 10.1016/j.coph.2003.10.007.
Hepatorenal syndrome is functional, reversible renal failure that occurs in patients with advanced liver cirrhosis or acute hepatic failure. The fundamental problem in hepatorenal syndrome is renal ischemia secondary to hypotension and profound renal cortical vasoconstriction. Sinusoidal hypertension and its associated splanchnic arterial vasodilatation initiate a cascade of events leading to activation of systemic and local vasoconstrictors and depletion of local renal vasodilators. Therapy with vasopressin V(1) receptor and alpha-adrenergic agonists, and plasma expanders, reverses type I and type II hepatorenal syndrome and improves survival. Large randomized, controlled, multicenter trials are needed to determine which drug is most effective, as well as the optimal dose and duration of treatment.
肝肾综合征是一种功能性、可逆性肾衰竭，发生于晚期肝硬化或急性肝衰竭患者。肝肾综合征的根本问题是继发于低血压和严重肾皮质血管收缩的肾缺血。肝窦高压及其相关的内脏动脉血管扩张引发一系列事件，导致全身和局部血管收缩剂激活以及局部肾血管扩张剂耗竭。使用血管加压素V(1)受体和α-肾上腺素能激动剂以及血浆扩容剂进行治疗，可逆转I型和II型肝肾综合征并提高生存率。需要进行大型随机对照多中心试验，以确定哪种药物最有效，以及最佳治疗剂量和疗程。
