Raina Rupesh, Sethi Sidharth K, Filler Guido, Menon Shina, Mittal Aliza, Khooblall Amrit, Khooblall Prajit, Chakraborty Ronith, Adnani Harsha, Vijayvargiya Nina, Teo Sharon, Bhatt Girish, Koh Lee Jin, Mourani Chebl, de Sousa Tavares Marcelo, Alhasan Khalid, Forbes Michael, Dhaliwal Maninder, Raghunathan Veena, Broering Dieter, Sultana Azmeri, Montini Giovanni, Brophy Patrick, McCulloch Mignon, Bunchman Timothy, Yap Hui Kim, Topalglu Rezan, Díaz-González de Ferris Maria
Cleveland Clinic Akron General Medical Center, Akron, OH, United States.
Department of Nephrology, Akron Children's Hospital, Akron, OH, United States.
Front Pediatr. 2022 Feb 2;9:833205. doi: 10.3389/fped.2021.833205. eCollection 2021.
Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.
小儿急性肝衰竭（ALF）和慢性肝衰竭急性发作（ACLF）的管理具有挑战性。肝衰竭的肾脏表现，如肝肾综合征（HRS）和急性肾损伤（AKI），越来越普遍，可能预示预后不良。ALF患儿中AKI的总体发病率尚未明确，部分原因是精确评估这些患者的肾功能存在困难。由于晚期肝功能不全患者以及患有包括休克和心血管功能不全伴肾灌注不良等危急情况的患者肌酐生成减少，小儿患者中AKI的真实发病率可能仍被低估。目前针对肝衰竭继发的肾功能不全的治疗包括保守治疗、静脉输液和肾脏替代治疗（KRT）。尽管关于在ALF背景下KRT应用于肾功能不全儿童的循证推荐很少，但已对专家临床意见进行了评估，内容涉及KRT的最佳方式和时机、透析/置换液、血液和透析液流速及透析剂量，以及抗凝方法。
