Desai Neel, Neugarten Joel, Dominguez Mary, Golestaneh Ladan
Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York.
Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York
Physiol Rep. 2017 Jun;5(11). doi: 10.14814/phy2.13301.
The role of "nephrocongestion" in hemodynamic renal disease is understudied. Intra-abdominal hypertension accompanies liver disease and renal disease. Our hypothesis states that in those patients with liver disease, hepatic vein pressure measured during a transjugular intrahepatic portosystemic shunt (TIPS) procedure reflects intra-abdominal pressure and predicts estimated glomerular filtration rate (eGFR). We gathered data from our clinical database and chart review on a cohort of cirrhotic patients who received TIPS at Montefiore as part of their clinical care between 2004 and 2014. We evaluated association of demographic and measured variables with eGFR in those subjects without end-stage renal disease (ESRD). Using multivariate regression, we examined the relationship between eGFR and hepatic vein pressure while adjusting for age, proteinuria, and ultrasound evidence for parenchymal kidney disease. The mean age of the subjects was 57 years old. Two thirds of the patients were male, 23% were White, and 20% were Black. A higher percentage of patients with chronic kidney disease (CKD), as determined by lower than 60 mL/min/1.73 m, had proteinuria and ultrasound evidence for parenchymal kidney disease. A multivariate linear regression showed a significant and negative association between hepatic vein pressure and eGFR when adjusting for age, race, and proteinuria. Hepatic vein pressure is negatively and significantly associated with eGFR in those patients with liver failure. This finding has major implications for the way we evaluate hemodynamic renal disease.
“肾充血”在血液动力学肾病中的作用尚未得到充分研究。腹内高压与肝脏疾病和肾脏疾病相伴。我们的假设是，在那些患有肝脏疾病的患者中，经颈静脉肝内门体分流术（TIPS）过程中测得的肝静脉压力反映腹内压力，并可预测估计肾小球滤过率（eGFR）。我们从临床数据库收集数据，并回顾了2004年至2014年间在蒙特菲奥里接受TIPS作为临床治疗一部分的一组肝硬化患者的病历。我们评估了非终末期肾病（ESRD）患者的人口统计学和测量变量与eGFR之间的关联。使用多元回归分析，我们在调整年龄、蛋白尿和实质性肾病的超声证据后，研究了eGFR与肝静脉压力之间的关系。受试者的平均年龄为57岁。三分之二的患者为男性，23%为白人，20%为黑人。根据低于60 mL/min/1.73 m²判断，慢性肾脏病（CKD）患者中蛋白尿和实质性肾病超声证据的比例更高。多元线性回归分析显示，在调整年龄、种族和蛋白尿后，肝静脉压力与eGFR之间存在显著负相关。在那些肝功能衰竭的患者中，肝静脉压力与eGFR呈显著负相关。这一发现对我们评估血液动力学肾病的方式具有重要意义。
