Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
Liver Int. 2016 Nov;36(11):1649-1656. doi: 10.1111/liv.13160. Epub 2016 Jun 30.
Hepatorenal syndrome (HRS) represents a severe form of renal injury in cirrhotic patients with ascites in the absence of certain triggers.
Patients with cirrhosis and ascites were longitudinally screened for renal dysfunction. HRS was diagnosed by an increase in serum creatinine (SCr) by ≥100% to ≥1.5 mg/dl. If specific triggers (i.e. nephrotoxins, parenchymal kidney damage, hypovolaemia, infections) were found, these cases were defined as specifically triggered acute kidney injury (sAKI).
Four hundred ninety-seven cirrhotic patients were screened for AKI and we identified 71 patients with HRS and 84 with sAKI. The most common triggers of sAKI were parenchymal damage in 33%, nephrotoxins in 30% and hypovolaemia in 29%. sAKI patients showed significantly more often complete remission than HRS patients (51% vs. 13%, P < 0.001), whereas persisting impairment of renal function was more common in HRS than in sAKI (56% vs. 37%, P = 0.006). Short-term (30 days) mortality was significantly higher in HRS than in sAKI (62% vs. 45%, P = 0.038). Remission rates and mortality varied between sAKI triggers. Transplant-free survival (TFS) was not significantly, but numerically lower in HRS than in sAKI [14 (IQR: 2-99) vs. 36 (IQR: 5-371) days; P = 0.102].
Patients with HRS show worse outcome and higher 30-day mortality than patients with severe triggered AKI. Different triggers of sAKI seem to influence prognosis. Prospective data are needed to implement effective screening and treatment algorithms for kidney injury in patients with cirrhosis and ascites.
肝肾综合征（HRS）代表了肝硬化腹水患者中严重的肾功能损伤形式，而无某些诱因。
对肝硬化和腹水患者进行肾功能障碍的纵向筛查。HRS 的诊断标准为血清肌酐（SCr）升高≥100%至≥1.5mg/dl。如果发现特定的诱因（即肾毒物、实质肾损伤、血容量不足、感染），则这些病例被定义为特定触发的急性肾损伤（sAKI）。
对 497 例肝硬化患者进行 AKI 筛查，我们发现 71 例 HRS 患者和 84 例 sAKI 患者。sAKI 最常见的诱因是实质损伤占 33%、肾毒物占 30%和血容量不足占 29%。sAKI 患者的完全缓解率明显高于 HRS 患者（51%对 13%，P<0.001），而 HRS 患者肾功能持续受损的比例高于 sAKI 患者（56%对 37%，P=0.006）。HRS 患者的短期（30 天）死亡率明显高于 sAKI 患者（62%对 45%，P=0.038）。sAKI 的不同诱因之间缓解率和死亡率存在差异。HRS 患者的无移植生存率（TFS）虽无显著差异，但数值上低于 sAKI 患者[14（IQR：2-99）对 36（IQR：5-371）天；P=0.102]。
与严重触发的 AKI 患者相比，HRS 患者的预后更差，30 天死亡率更高。sAKI 的不同诱因似乎影响预后。需要前瞻性数据来为肝硬化和腹水患者的肾损伤制定有效的筛查和治疗方案。
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