Cardiovascular Division, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
J Card Fail. 2013 Nov;19(11):739-45. doi: 10.1016/j.cardfail.2013.10.005. Epub 2013 Oct 17.
Differentiation of HF-induced renal dysfunction (RD) from irreversible intrinsic kidney disease is challenging, likely related to the multifactorial pathophysiology underlying HF-induced RD. In contrast, HF-induced liver dysfunction results in characteristic laboratory abnormalities. Given that similar pathophysiologic factors are thought to underlie both conditions, and that the liver and kidneys share a common circulatory environment, patients with laboratory evidence of HF-induced liver dysfunction may also have a high incidence of potentially reversible HF-induced RD.
Hospitalized patients with a discharge diagnosis of HF were reviewed (n = 823). Improvement in renal function (IRF) was defined as a 20% improvement in estimated glomerular filtration rate (eGFR). An elevated international normalized ratio (INR; odds ratio [OR] 2.8; P < .001), bilirubin (BIL; OR 2.2; P < .001), aspartate aminotransferase (AST; OR 1.8; P = .004), and alanine aminotransferase (ALT; OR 2.1; P = .001) were all significantly associated with IRF. Among patients with baseline RD (eGFR ≤45 mL min(-1) 1.73 m(-2)), associations between liver dysfunction and IRF were particularly strong (INR: OR 5.7 [P < .001]; BIL: OR 5.1 [P < .001]; AST: OR 2.9 [P = .005]; ALT: OR 4.8 [P < .001]).
Biochemical evidence of mild liver dysfunction is associated with reversible RD in decompensated HF patients. In the absence of methodology to directly identify HF-induced RD, signs of HF-induced dysfunction of other organs may serve as an accessible method by which HF-induced RD is recognized.
HF 引起的肾功能障碍（RD）与不可逆的固有肾脏疾病的区分具有挑战性，这可能与 HF 引起的 RD 背后的多因素病理生理学有关。相比之下，HF 引起的肝功能障碍会导致特征性的实验室异常。鉴于认为相似的病理生理因素可能是这两种情况的基础，并且肝脏和肾脏具有共同的循环环境，因此具有 HF 引起的肝功能障碍实验室证据的患者也可能具有较高的潜在可逆转 HF 引起的 RD 发生率。
回顾性分析了因 HF 出院诊断的住院患者（n=823）。肾功能改善（IRF）定义为估计肾小球滤过率（eGFR）提高 20%。国际标准化比值（INR；优势比[OR]2.8；P<.001）、胆红素（BIL；OR 2.2；P<.001）、天门冬氨酸氨基转移酶（AST；OR 1.8；P=.004）和丙氨酸氨基转移酶（ALT；OR 2.1；P=.001）升高均与 IRF 显著相关。在基线 RD 患者（eGFR≤45 mL min(-1) 1.73 m(-2)）中，肝功能障碍与 IRF 之间的关联尤其强烈（INR：OR 5.7[P<.001]；BIL：OR 5.1[P<.001]；AST：OR 2.9[P=.005]；ALT：OR 4.8[P<.001]）。
失代偿性 HF 患者轻度肝功能障碍的生化证据与可逆性 RD 相关。在没有直接识别 HF 引起的 RD 的方法的情况下，其他器官的 HF 引起的功能障碍的迹象可能是识别 HF 引起的 RD 的一种可行方法。
