Rajakumar Akila, Appuswamy Ellango, Kaliamoorthy Ilankumaran, Rela Mohamed
Department of Liver Anaesthesia and Intensive Care, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India.
Department of Liver Anaesthesia and Intensive Care, Gleneagles Global Health City, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2021 Feb;25(2):207-214. doi: 10.5005/jp-journals-10071-23721.
Cirrhotic patients with manifestations of the end-stage liver disease have a high risk for developing renal dysfunction even with minor insults. The development of renal dysfunction increases the morbidity and mortality of these patients. Causes of renal dysfunction in cirrhotics can be due to hepatorenal syndrome (HRS) or acute kidney injury (AKI) resulting from prerenal, renal, and postrenal causes. Development of pretransplant renal dysfunction has been shown to affect post-liver transplantation outcomes. Early detection and aggressive strategies for the prevention of further progression of renal dysfunction seem to decrease the morbidity and improve survival in this group of patients. This article aims to outline the pathogenesis of renal dysfunction in cirrhosis, etiological factors, and evaluation of renal dysfunction, strategies for aggressive therapy for renal dysfunction, the indications of renal replacement therapy (RRT) in this group of patients, and the various modalities of RRT with their merits and demerits. A thorough understanding of the pathogenesis, early detection, and aggressive corrective measures for AKI can prevent further progression. In conclusion, a good knowledge of treatment modalities available for renal dysfunction in cirrhosis and institution of timely interventions can significantly improve survival in this group of patients.
Development of renal dysfunction in cirrhotics increases the morbidity and mortality of these patients and results in poor outcomes after liver transplantation. Early detection and aggressive strategies for the prevention of further progression of renal dysfunction seem to decrease the morbidity and improve survival in this group of patients.
Rajakumar A, Appuswamy E, Kaliamoorthy I, Rela M. Renal Dysfunction in Cirrhosis: Critical Care Management. Indian J Crit Care Med 2021;25(2):207-214.
即使受到轻微损伤，出现终末期肝病表现的肝硬化患者发生肾功能障碍的风险也很高。肾功能障碍的发生会增加这些患者的发病率和死亡率。肝硬化患者肾功能障碍的原因可能是肝肾综合征（HRS）或由肾前性、肾性和肾后性原因导致的急性肾损伤（AKI）。移植前肾功能障碍的发生已被证明会影响肝移植后的结局。早期检测以及积极预防肾功能障碍进一步进展的策略似乎可以降低发病率并提高这组患者的生存率。本文旨在概述肝硬化患者肾功能障碍的发病机制、病因、肾功能障碍的评估、肾功能障碍的积极治疗策略、这组患者肾脏替代治疗（RRT）的指征以及RRT的各种方式及其优缺点。深入了解AKI的发病机制、早期检测和积极的纠正措施可以防止病情进一步发展。总之，充分了解肝硬化患者肾功能障碍可用的治疗方式并及时进行干预可以显著提高这组患者的生存率。
肝硬化患者发生肾功能障碍会增加这些患者的发病率和死亡率，并导致肝移植后预后不良。早期检测以及积极预防肾功能障碍进一步进展的策略似乎可以降低发病率并提高这组患者的生存率。
拉贾库马尔A，阿普斯瓦米E，卡里亚穆尔蒂I，雷拉M。肝硬化患者的肾功能障碍：重症监护管理。《印度重症医学杂志》2021年；25（2）：207 - 214。
