Division of Gastroenterology/Liver, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, France.
Curr Opin Nephrol Hypertens. 2021 Sep 1;30(5):501-506. doi: 10.1097/MNH.0000000000000730.
Hepatorenal syndrome (HRS) is encountered frequently in patients with end-stage liver disease and remains an important cause of morbidity and mortality in this patient population. This review will focus and provide updates on pathophysiology, assessment of kidney function, new definitions, and treatment and prevention of HRS.
Pathophysiology of HRS has been elucidated more recently and in addition to hemodynamic changes, the role of systemic inflammatory response contributes significantly to this process. Assessment of kidney function in patients with liver cirrhosis remains challenging. Novel glomerular filtration rate equations have been developed in patients with liver disease to better estimate kidney function and changes made in the definition of acute kidney injury (AKI), which are more aligned with KDIGO criteria for AKI. Vasoconstrictors, especially terlipressin, along with albumin remain the mainstay of pharmacological treatment of HRS-AKI. Biomarkers have been useful in differentiating ATN from HRS at an early stage.
HRS remains a significant cause of morbidity and mortality for patients with end-stage liver disease. Newer understanding of mechanisms in development and pathophysiology of HRS have helped with elucidation of the disease process.
肝肾综合征（HRS）在终末期肝病患者中经常发生，仍然是该患者人群发病率和死亡率的重要原因。本综述将重点介绍和更新 HRS 的病理生理学、肾功能评估、新定义以及治疗和预防。
HRS 的病理生理学最近得到了更深入的研究，除了血流动力学变化外，全身炎症反应的作用对这一过程也有重要贡献。肝硬化患者的肾功能评估仍然具有挑战性。已经为肝病患者开发了新的肾小球滤过率方程，以更好地估计肾功能，并对急性肾损伤（AKI）的定义进行了修改，使其与 AKI 的 KDIGO 标准更一致。血管收缩剂，特别是特利加压素，以及白蛋白仍然是 HRS-AKI 药物治疗的主要方法。生物标志物在早期区分 ATN 与 HRS 方面非常有用。
HRS 仍然是终末期肝病患者发病率和死亡率的重要原因。对 HRS 发病机制和病理生理学的新认识有助于阐明疾病过程。
