Renal failure in fulminant hepatic failure and terminal cirrhosis: a comparison between incidence, types, and prognosis.
Renal failure in fulminant hepatic failure and terminal cirrhosis: a comparison between incidence, types, and prognosis.
复制标题
暴发性肝衰竭和终末期肝硬化中的肾衰竭：发病率、类型和预后之间的比较。
作者：
H. Ring‐Larsen;U. Palazzo
40例终末期肝硬化和40例暴发性肝功能衰竭患者均连续入院，研究了并发肾功能不全的发生率、类型和预后。当血清肌酐大于0.20 mmol/l时，认为存在肾衰竭。在肝硬化患者中，26例（65%）发生肾衰竭。15例为功能性，3例为急性肾小管坏死，8例为不确定性。在暴发性肝衰竭患者中，22例（55%）有肾功能不全;其中13例有功能性肾衰竭，5例急性肾小管坏死，4例类型无法确定。在这两类患者中，肾衰竭在有或无消化道出血以及有或无腹水或利尿剂治疗的患者中同样常见。在两类患者中，肝功能的生化检查在有或无肾衰竭的患者中相似。7例暴发性肝功能衰竭患者的平均肾血流量与先前在肝硬化患者中观察到的顺序相同。在终末期肝硬化中，有肾功能衰竭的死亡率为88%，无肾功能衰竭的死亡率为71%（p> 0.05），而暴发性肝衰竭的死亡率为100%和67%（p <0.05）。在这两种情况下，肾衰竭的发生率、相对频率和预后没有差异，表明病理生理学情况相同。
Forty patients with terminal cirrhosis and 40 patients with fulminant hepatic failure-all consecutively admitted-were studied with regard to incidence, types, and prognosis of complicating renal insufficiency. Renal failure was considered present when the serum creatinine was greater than 0.20 mmol/l. Of the patients with cirrhosis 26 (65%) developed renal failure. In 15 the type was functional, in three due to acute tubular necrosis, and in eight indeterminable. Of the patients with fulminant hepatic failure 22 (55%) had renal insufficiency; of these 13 had functional renal failure, five acute tubular necrosis, and in four the type was indeterminable. In both categories of patients, renal failure was equally frequent among patients with or without gastrointestinal bleeding and with or without ascites or diuretic therapy. The biochemical tests of liver function were similar in patients with or without renal failure in both categories. The mean renal blood flow in seven unselected patients with fulminant hepatic failure was reduced in the same order as previously observed in patients with cirrhosis. In terminal cirrhosis the mortality rate was 88% in the presence of renal failure, 71% in its absence (p greater than 0.05), while the same figures in fulminant hepatic failure were 100% and 67% (p less than 0.05). The incidence, relative frequency, and prognosis of renal failure were not different in the two conditions, indicating identical pathophysiological circumstances.