Pillebout Evangéline
Service de néphrologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Nephrol Ther. 2014 Feb;10(1):61-8. doi: 10.1016/j.nephro.2013.11.005. Epub 2014 Jan 1.
Hepatorenal syndrome is a severe complication of end-stage liver disease. The pathophysiological hallmark is severe renal vasoconstriction, resulting from peripheral and splanchnic vasodilation as well as activation of renal vasoconstrictor molecules, which induce the effective arterial volume reduction and the functional renal failure. The diagnosis of hepatorenal syndrome is currently based on the exclusion of other causes of renal failure (especially prerenal). Spontaneous bacterial peritonitis is one of the triggering factors and should be sought in all patients with severe liver disease and acute renal failure. Quickly treating patients with parental antibiotics and albumin infusion significantly decreases the risk. The combined use of intravenous albumin, splanchnic and peripheral vasoconstrictor and/or renal replacement therapy sometimes enables a delay until liver transplantation (or combined liver-kidney in selected patients). Transplantation is in fact the only way to improve the long-term prognosis.
肝肾综合征是终末期肝病的一种严重并发症。其病理生理特征是严重的肾血管收缩，这是由外周和内脏血管扩张以及肾血管收缩分子的激活所致，这些因素会导致有效动脉血容量减少和功能性肾衰竭。肝肾综合征的诊断目前基于排除其他肾衰竭原因（尤其是肾前性原因）。自发性细菌性腹膜炎是触发因素之一，所有严重肝病和急性肾衰竭患者均应排查。迅速给予患者静脉用抗生素和输注白蛋白可显著降低风险。静脉输注白蛋白、内脏和外周血管收缩剂及/或肾脏替代治疗联合使用有时可使患者推迟至肝移植（或在特定患者中进行肝肾联合移植）。事实上，移植是改善长期预后的唯一方法。
