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肝硬化患者急性肾损伤的诊断与治疗进展

Advances in the Diagnosis and Treatment of Acute Kidney Injury in Cirrhosis Patients.

作者信息

Lei Lei, Li Liangping, Zhang Hu

机构信息

Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.

Department of Gastroenterology and Hepatology, Sichuan Provincial People's Hospital, Chengdu, China.

出版信息

Biomed Res Int. 2017;2017:8523649. doi: 10.1155/2017/8523649. Epub 2017 May 10.

Abstract

Liver cirrhosis is a common progressive and chronic clinical liver disease. Due to the strong compensation ability of the liver, no obvious symptoms develop in the early stage. However, multiple systems are involved in decompensation of the liver. Acute kidney injury (AKI) is one of the most serious complications, characterized by a sharp drop in the glomerular filtration rate (GFR); a rapid increase in Scr and BUN, as well as sodium and water storage; and a disturbance of acid-base balance. The mortality rate is high, and the prognosis is very poor. Thus, it is important to make a definite diagnosis and initiate treatment in the early stage to decrease mortality and improve the prognosis. Although diagnosing liver cirrhosis with serum creatinine has many shortcomings, a dynamic change in this marker is still the main diagnostic criterion for AKI. Identifying new markers of kidney injury with clinical value has also become an increasing focus of research. In this text, we review recent changes regarding categorization of AKI diagnostic criteria as well as new markers of AKI and treatments for cirrhosis-related AKI.

摘要

肝硬化是一种常见的进行性慢性临床肝脏疾病。由于肝脏强大的代偿能力,早期通常无明显症状。然而,肝脏失代偿会累及多个系统。急性肾损伤(AKI)是最严重的并发症之一,其特征为肾小球滤过率(GFR)急剧下降;血肌酐(Scr)和血尿素氮(BUN)迅速升高,以及钠水潴留;并伴有酸碱平衡紊乱。死亡率高,预后很差。因此,早期明确诊断并开始治疗以降低死亡率和改善预后很重要。尽管用血清肌酐诊断肝硬化有许多缺点,但该指标的动态变化仍是急性肾损伤的主要诊断标准。识别具有临床价值的新型肾损伤标志物也日益成为研究的重点。在本文中,我们综述了急性肾损伤诊断标准分类的最新变化以及急性肾损伤的新型标志物和肝硬化相关急性肾损伤的治疗方法。

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