Department of Transplantation, College of Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA.
Semin Respir Crit Care Med. 2012 Feb;33(1):55-69. doi: 10.1055/s-0032-1301735. Epub 2012 Mar 23.
Acute kidney injury (AKI) is common in cirrhotic patients with ascites. Although not the primary etiology of AKI in cirrhotic patients, hepatorenal syndrome (HRS) is a unique form of AKI that develops only in cirrhotic patients. Intense renal vasoconstriction is the hallmark of HRS. Different mechanisms contribute to renal vasoconstriction, with splanchnic vasodilatation and reduced effective blood volume playing a central role. Diagnostic criteria for HRS have been developed and were recently modified, but diagnosing HRS and differentiating it from other causes of AKI in cirrhotic patients continues to be a difficult task in some patients. Given its overall dismal prognosis, strategies to prevent HRS have been developed and proved to be effective in reducing HRS prevalence among cirrhotic patients. Liver transplantation is the ultimate treatment, but more than one treatment modality can be utilized as a bridge to transplantation. This review provides an update on our current understanding of HRS with emphasis on the underlying pathophysiological mechanisms involved, difficulties in diagnosis, and different treatment modalities.
急性肾损伤（AKI）在肝硬化伴腹水患者中很常见。虽然肝肾综合征（HRS）不是肝硬化患者 AKI 的主要病因，但它是一种仅在肝硬化患者中发生的独特 AKI 形式。强烈的肾血管收缩是 HRS 的标志。不同的机制导致肾血管收缩，其中内脏血管舒张和有效血容量减少起着核心作用。已经制定了 HRS 的诊断标准，并最近进行了修改，但在某些患者中，诊断 HRS 并将其与肝硬化患者 AKI 的其他原因区分开来仍然是一项艰巨的任务。鉴于其总体预后不良，已经制定了预防 HRS 的策略，并已证明在降低肝硬化患者 HRS 的患病率方面有效。肝移植是最终的治疗方法，但可以使用多种治疗方式作为移植的桥梁。本综述提供了对 HRS 的最新认识，重点介绍了所涉及的潜在病理生理机制、诊断困难和不同的治疗方式。
