Bucsics Theresa, Krones Elisabeth
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
Gastroenterol Rep (Oxf). 2017 May;5(2):127-137. doi: 10.1093/gastro/gox009. Epub 2017 Apr 24.
Renal dysfunction is a common complication of liver cirrhosis and of utmost clinical and prognostic relevance. Patients with cirrhosis are more prone to developing acute kidney injury (AKI) than the non-cirrhotic population. Pre-renal AKI, the hepatorenal syndrome type of AKI (HRS-AKI, formerly known as 'type 1') and acute tubular necrosis represent the most common causes of AKI in cirrhosis. Correct differentiation is imperative, as treatment differs substantially. While pre-renal AKI usually responds well to plasma volume expansion, HRS-AKI and ATN require different specific approaches and are associated with substantial mortality. Several paradigms, such as the threshold of 2.5 mg/dL for diagnosis of HRS-AKI, have recently been abolished and novel urinary biomarkers are being investigated in order to facilitate early and correct diagnosis and treatment of HRS-AKI and other forms of AKI in patients with cirrhosis. This review summarizes the current diagnostic criteria, as well as pathophysiologic and therapeutic concepts for AKI and HRS-AKI in cirrhosis.
肾功能不全是肝硬化常见的并发症，具有极其重要的临床和预后意义。肝硬化患者比非肝硬化人群更容易发生急性肾损伤（AKI）。肾前性AKI、肝肾综合征型AKI（HRS-AKI，以前称为“1型”）和急性肾小管坏死是肝硬化患者AKI最常见的病因。正确区分至关重要，因为治疗方法差异很大。虽然肾前性AKI通常对血浆容量扩充反应良好，但HRS-AKI和急性肾小管坏死需要不同的特定治疗方法，且死亡率很高。最近，一些标准，如诊断HRS-AKI的阈值2.5mg/dL已被废除，并且正在研究新型尿液生物标志物，以促进肝硬化患者HRS-AKI和其他形式AKI的早期和正确诊断及治疗。本综述总结了目前肝硬化患者AKI和HRS-AKI的诊断标准以及病理生理和治疗概念。
