Assistant Professor, Department of Anesthesiology, Division of Critical Care, Columbia University, New York, NY, USA.
Curr Opin Anaesthesiol. 2010 Apr;23(2):139-44. doi: 10.1097/ACO.0b013e32833724a8.
The development of hepatorenal syndrome in liver cirrhosis leads to an increased morbidity and mortality in patients with cirrhosis. Currently, there are no proven methods for the treatment or prevention of hepatorenal syndrome except to maintain adequate hemodynamics and intravascular volume in this patient population. These patients will frequently require renal replacement therapy when presenting for hepatic transplantation.
New consensus definitions have been published in order to create uniform standards for classifying and diagnosing acute kidney injury. Two such groups are the Acute Dialysis Quality Initiative (ADQI) and the Acute Kidney Injury Network (AKIN), which have proposed approaches to defining criteria for acute kidney injury. Recent literature supports not only the role of splanchnic vasodilation and systemic vasoconstriction but also heart failure in the pathogenesis of hepatorenal syndrome. The practice of using vasoconstrictor and intravenous albumin therapy for the treatment of hepatorenal syndrome is ongoing with a growing body of recent data supporting the use of vasopressin analogs as the first-line therapy in the ICU setting with knowledge of the possible cardiovascular side-effects.
Hepatorenal syndrome, HRS, is a diagnosis of exclusion. There are two forms of hepatorenal syndrome: type 1 hepatorenal syndrome and type 2 hepatorenal syndrome. Type 1 HRS is rapidly progressive and portends a very poor prognosis and has a high mortality rate. Type 2 is more indolent while still associated with an overall poor prognosis. Treatment of HRS is largely still supportive. It is imperative to maintain euvolemia and hemodynamics in this patient population to optimize renal perfusion and preserve renal function. Renal replacement therapy may be necessary in this chronically ill patient population, if renal function deteriorates such that the kidneys cannot maintain metabolic and volume homeostasis. Further research is still necessary as to the prevention and effective treatment for hepatorenal syndrome.
肝硬化患者发生肝肾综合征会导致其发病率和死亡率升高。目前，除了维持此类患者人群的血容量和血流动力学稳定外，尚无针对肝肾综合征的治疗或预防方法。这些患者在进行肝移植时通常需要肾脏替代治疗。
为了创建用于分类和诊断急性肾损伤的统一标准，已经发布了新的共识定义。急性透析质量倡议 (ADQI) 和急性肾损伤网络 (AKIN) 是两个这样的组织，它们提出了定义急性肾损伤标准的方法。最近的文献不仅支持内脏血管舒张和全身血管收缩的作用，还支持心力衰竭在肝肾综合征发病机制中的作用。目前正在使用血管收缩剂和静脉白蛋白治疗肝肾综合征，越来越多的最新数据支持在 ICU 环境中使用血管加压素类似物作为一线治疗方法，同时了解其可能的心血管副作用。
肝肾综合征，HRS，是一种排除性诊断。肝肾综合征有两种类型：1 型肝肾综合征和 2 型肝肾综合征。1 型 HRS 进展迅速，预后极差，死亡率高。2 型较为缓慢，但仍与整体预后不良相关。HRS 的治疗主要还是支持性治疗。在这一慢性疾病患者人群中，必须保持血容量和血流动力学正常，以优化肾脏灌注并保护肾功能。如果肾功能恶化，肾脏无法维持代谢和容量平衡，这一慢性疾病患者人群可能需要肾脏替代治疗。仍需要进一步研究以预防和有效治疗肝肾综合征。
