Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.
Cardiorenal Med. 2021;11(4):161-165. doi: 10.1159/000517363. Epub 2021 Jul 14.
Objective assessment of fluid status is of utmost significance in the management of patients with complex disorders involving hemodynamics and multi-organ crosstalk such as cardiorenal or hepatorenal syndrome. The role of volume expansion using intravenous albumin in the setting of hepatorenal syndrome has been an everlasting debate among clinicians. With the accumulating evidence on the deleterious consequences of iatrogenic fluid overload, empiric albumin administration in these patients has been the focus of much attention, and the findings of recent studies suggest a higher incidence of pulmonary complications with albumin. Poor sensitivity of conventional physical examination has led to an interest in the utility of novel noninvasive bedside tools such as point-of-care ultrasonography (POCUS) to evaluate hemodynamics more precisely. Once confined to specialties such as obstetrics and emergency medicine, the scope of diagnostic POCUS is rapidly expanding in other fields including internal medicine and nephrology. Herein, we offer our perspective on the emerging role of POCUS for objective evaluation of patients with suspected hepatorenal physiology based on our experience. We propose that future clinical trials consider incorporating this strategy and explore the impact of POCUS-guided therapy on the outcomes.
客观评估液体状态对于涉及血液动力学和多器官相互作用的复杂疾病患者的管理至关重要，例如心肾或肝肾综合征。在肝肾综合征中使用静脉白蛋白进行容量扩张的作用一直是临床医生争论的焦点。随着关于医源性液体超负荷的有害后果的证据不断积累，经验性白蛋白在这些患者中的应用受到了广泛关注，最近的研究结果表明白蛋白治疗与更高的肺部并发症发生率相关。传统体格检查的敏感性较差，促使人们对新型非侵入性床边工具（如即时床边超声检查[POCUS]）的使用产生了兴趣，以更精确地评估血液动力学。POCUS 曾经仅限于妇产科和急诊医学等专业领域，但其诊断范围正在迅速扩展到其他领域，包括内科和肾脏病学。在此，我们根据经验提供了关于 POCUS 在评估疑似肝肾生理患者中的新兴作用的观点。我们建议未来的临床试验考虑纳入这一策略，并探讨 POCUS 指导治疗对结果的影响。
