Aguirre-Villarreal David, Leal-Villarreal Mario Andrés de Jesús, García-Juárez Ignacio, Argaiz Eduardo R, Koratala Abhilash
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico.
World J Crit Care Med. 2024 Jun 9;13(2):91212. doi: 10.5492/wjccm.v13.i2.91212.
This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term "hepatocardiorenal syndrome" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.
本文深入探讨了肝硬化患者急性肾损伤（AKI）的复杂挑战，这种情况发病率和死亡率都很高。复杂性源于区分肝硬化患者急性肾损伤的各种原因，尤其是血流动力学急性肾损伤，这些患者因门静脉高压而出现血流动力学变化。引入了“肝心肾综合征”这一术语来概括肝脏、心脏和肾脏之间复杂的相互作用。该叙述强调了肝硬化患者急性肾损伤评估中心脏功能这一常被忽视的方面，揭示了以舒张功能受损为特征的肝硬化性心肌病的普遍性。对用于肝肾综合征的传统经验性方法，即容量扩张和使用血管加压药进行了批判性分析，强调了潜在风险和患者的不同反应。我们提倡一种针对肝硬化患者急性肾损伤评估的细致入微的算法，其中重点是床旁超声检查（POCUS）。POCUS的应用包括评估液体耐受性、检测静脉淤血和评估心脏功能。
