Arroyo Vicente, Torre Aldo, Guevara Mónica
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona School of Medicine, Barcelona, Catalunya, Spain.
Trop Gastroenterol. 2005 Jan-Mar;26(1):13-20.
Hepatorenal syndrome is a common complication of advanced cirrhosis, characterized by renal failure and major disturbances in circulatory function. Renal failure is caused by intense vasoconstriction of the renal circulation. The syndrome is probably the final consequence of extreme underfilling of the arterial circulation secondary to arterial vasodilatation in the splanchninc vascular bed. The diagnosis of HRS is currently based on the exclusion of other causes of renal failure. The prognosis is very poor, particularly when there is rapidly progressive renal failure (type 1). Liver transplantation is the best option in patients without contraindications to the procedure, but it is not always possible owing to the short survival expectancy. Therapies introduced during the past few years, such a vasoconstrictor drugs (vasopressin analogues, mu-adrenergic agonist) or the transjugular intrahepatic portosystemic shunt, are effective in improving renal function. Nevertheless, liver transplantation should still be done in suitable patients even after improvement of renal function because the outcome of HRS is poor.
肝肾综合征是晚期肝硬化的常见并发症，其特征为肾衰竭和循环功能的严重紊乱。肾衰竭由肾循环的强烈血管收缩引起。该综合征可能是由于内脏血管床动脉血管扩张继发动脉循环极度充盈不足的最终结果。肝肾综合征的诊断目前基于排除其他肾衰竭原因。预后非常差，尤其是在出现快速进行性肾衰竭（1型）时。对于无该手术禁忌证的患者，肝移植是最佳选择，但由于预期生存期短，并非总是可行。过去几年引入的治疗方法，如血管收缩剂药物（血管加压素类似物、μ-肾上腺素能激动剂）或经颈静脉肝内门体分流术，在改善肾功能方面有效。然而，即使肾功能改善后，仍应在合适的患者中进行肝移植，因为肝肾综合征的预后较差。
