Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Italy.
Semin Liver Dis. 2018 Aug;38(3):230-241. doi: 10.1055/s-0038-1661372. Epub 2018 Jul 24.
Patients with cirrhosis have a high prevalence of renal dysfunction. The susceptibility to renal dysfunction is due to both the severe splanchnic arterial vasodilation and the systemic inflammation observed in these patients. An accurate assessment of renal function is recommended in all patients with cirrhosis. Indeed, the renal function assessment guides the management of patients, helps to refine prognosis and to define transplant strategies. Despite its limitations, serum creatinine is still the most used biomarker for the estimation of glomerular filtration rate (GFR) and the assessment of acute kidney injury (AKI) in patients with cirrhosis. New biomarkers of GFR such as cystatin C may improve the assessment of GFR and the prognostic stratification in these patients. AKI is a life-threatening complication and needs a timely management. The differential diagnosis between hepatorenal syndrome (HRS) and acute tubular necrosis (ATN) is tricky in clinical practice. New biomarkers of kidney injury, such as neutrophil gelatinase-associated lipocalin and interleukin-18, represent useful tools in refining the discrimination between HRS and ATN. Patients with HRS need a prompt treatment with vasoconstrictors and albumin and a rapid evaluation for liver transplant eligibility. In this article, the authors reviewed the available tools in the diagnosis and management of renal dysfunction in cirrhosis.
肝硬化患者肾功能障碍的发生率很高。这些患者存在严重的内脏动脉血管舒张和全身炎症，易发生肾功能障碍。建议所有肝硬化患者都进行准确的肾功能评估。事实上，肾功能评估指导患者的管理，有助于改善预后并确定移植策略。尽管存在局限性，但血清肌酐仍然是肝硬化患者估计肾小球滤过率（GFR）和评估急性肾损伤（AKI）最常用的生物标志物。GFR 的新生物标志物，如胱抑素 C，可能会改善这些患者的 GFR 评估和预后分层。AKI 是一种危及生命的并发症，需要及时治疗。在临床实践中，肝肾综合征（HRS）和急性肾小管坏死（ATN）之间的鉴别诊断很棘手。新的肾损伤生物标志物，如中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-18，是区分 HRS 和 ATN 的有用工具。HRS 患者需要立即使用血管收缩剂和白蛋白进行治疗，并迅速评估是否适合进行肝移植。本文作者综述了肝硬化患者肾功能障碍的诊断和治疗中可用的工具。
