Kiani Calvin, Zori Andreas G
Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Florida, Gainesville, FL 32610, United States.
World J Hepatol. 2023 Jun 27;15(6):741-754. doi: 10.4254/wjh.v15.i6.741.
Hepatorenal syndrome with acute kidney injury (HRS-AKI) is a form of rapidly progressive kidney dysfunction in patients with decompensated cirrhosis and/or acute severe liver injury such as acute liver failure. Current data suggest that HRS-AKI occurs secondary to circulatory dysfunction characterized by marked splanchnic vasodilation, leading to reduction of effective arterial blood volume and glomerular filtration rate. Thus, volume expansion and splanchnic vasoconstriction constitute the mainstay of medical therapy. However, a significant proportion of patients do not respond to medical management. These patients often require renal replacement therapy and may be eligible for liver or combined liver-kidney transplantation. Although there have been advances in the management of patients with HRS-AKI including novel biomarkers and medications, better-calibrated studies, more widely available biomarkers, and improved prognostic models are sorely needed to further improve diagnosis and treatment of HRS-AKI.
肝肾综合征合并急性肾损伤（HRS-AKI）是失代偿期肝硬化和/或急性严重肝损伤（如急性肝衰竭）患者中一种快速进展的肾功能障碍形式。目前的数据表明，HRS-AKI继发于以显著内脏血管扩张为特征的循环功能障碍，导致有效动脉血容量和肾小球滤过率降低。因此，扩容和内脏血管收缩构成了药物治疗的主要手段。然而，相当一部分患者对药物治疗无反应。这些患者通常需要肾脏替代治疗，并且可能适合进行肝移植或肝肾联合移植。尽管在HRS-AKI患者的管理方面取得了进展，包括新型生物标志物和药物，但仍迫切需要校准更好的研究、更广泛可用的生物标志物以及改进的预后模型，以进一步改善HRS-AKI的诊断和治疗。
