Bataller R, Ginès P, Guevara M, Arroyo V
Department of Medicine, Hospital Clínic i Provincial, University of Barcelona, Catalunya, Spain.
Semin Liver Dis. 1997;17(3):233-47. doi: 10.1055/s-2007-1007201.
Hepatorenal syndrome is a common complication in patients with advanced cirrhosis and ascites characterized not only by renal failure but also by marked alterations in systemic hemodynamics and vasoactive systems. Renal failure is due to a marked hypoperfusion of the kidney secondary to renal vasoconstriction. The pathogenesis of hepatorenal syndrome is not completely known but it is thought to be the extreme manifestation of the underfilling of the arterial circulation secondary to an arterial vasodilation, located mainly in the splanchnic circulation. Recently, a new definition and diagnostic criteria of hepatorenal syndrome have been proposed, which has stimulated research in this field. Prognosis of patients with hepatorenal syndrome is very poor. Liver transplantation is the only effective treatment but it is not applicable in all patients due to short survival. New therapies developed during the last few years, such as the use of systemic vasoconstrictors or transjugular intrahepatic portosystemic shunts appear promising, but their usefulness should be evaluated in prospective investigations.
肝肾综合征是晚期肝硬化和腹水患者的常见并发症，其不仅以肾衰竭为特征，还伴有全身血流动力学和血管活性系统的显著改变。肾衰竭是由于肾血管收缩继发的肾脏严重灌注不足所致。肝肾综合征的发病机制尚未完全明确，但一般认为它是主要位于内脏循环的动脉血管扩张继发的动脉循环血容量不足的极端表现。最近，有人提出了肝肾综合征的新定义和诊断标准，这推动了该领域的研究。肝肾综合征患者的预后很差。肝移植是唯一有效的治疗方法，但由于患者生存期短，并非适用于所有患者。过去几年开发的新疗法，如使用全身性血管收缩剂或经颈静脉肝内门体分流术，似乎很有前景，但它们的有效性应在前瞻性研究中进行评估。
