The Treatment of Hepatorenal Syndrome
The Treatment of Hepatorenal Syndrome
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DOI：
10.1159/000375346
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发表时间：
2015-01-01
影响因子：
2.3
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
--
作者：
Cavallin, Marta;Fasolato, Silvano;Angeli, Paolo
肝肾综合征（HRS）是一种严重的并发症，常发生在肝硬化和腹水患者。HRS是一种功能性肾功能衰竭，主要是由严重的心血管功能障碍引起的，其特征是内脏动脉血管极度扩张和心输出量减少。HRS可发展为两种临床类型：急性和快速进行性肾衰竭（AKI-HRS）或慢性和非进行性肾衰竭（CKD-HRS）。一些小型研究和一些随机对照研究已经发表了特利加压素加白蛋白治疗HRS的研究，主要是针对AKI-HRS。特利加压素加白蛋白可改善近35-45%的AKI-HRS患者的肾功能，并改善这些患者的短期生存。特利加压素最常用于静脉注射，在无反应的情况下，从初始剂量每4小时0.5-1毫克增加到每4小时3毫克。在其他研究中，特利加压素也通过持续静脉输注给予。因此，特利加压素治疗HRS的最佳方法尚未确定。a-肾上腺素能药物，如静脉注射去甲肾上腺素或口服midodrine加皮下奥曲肽，与白蛋白一起使用，也被用于治疗AKI-HRS，效果很好。然而，我们需要进一步的研究来确定它们是否能代表一种真正的治疗选择。总之，现有数据足以说明特利加压素加白蛋白的使用确实改变了HRS的管理。然而，一些关键的未解决的问题仍然存在，特别是：(a)如何预测治疗无反应，(b)如何管理治疗无反应，以及(c)在优先分配过程中如何考虑肝移植候选者的反应。(C) 2015 S. Karger AG，巴塞尔
Hepatorenal syndrome (HRS) is a severe complication that often occurs in patients with cirrhosis and ascites. HRS is a functional renal failure that develops mainly as a consequence of a severe cardiovascular dysfunction which is characterized by an extreme splanchnic arterial vasodilation and a reduction of cardiac output. HRS may develop in two clinical types: as an acute and rapidly progressive renal failure (AKI-HRS) or as chronic and not progressive renal failure (CKD-HRS). Several small studies and some randomized control studies have been published on the use of terlipressin plus albumin in the treatment of HRS, mainly on AKI-HRS. Terlipressin plus albumin was shown to improve renal function in almost 35-45% of patients with AKI-HRS, as well as to improve short-term survival in these patients. Terlipressin was most commonly used by intravenous boluses moving from an initial dose of 0.5-1 mg every 4 h to 3 mg every 4 h in the case of a nonresponse. In other studies, terlipressin was also given by continuous intravenous infusion. Thus, the best way to administer terlipressin in the treatment of HRS has not yet been defined. a-Adrenergic drugs, such as intravenous norepinephrine or oral midodrine plus subcutaneous octreotide, administered with albumin have also been used in the treatment of AKI-HRS, with promising results. However, we need further studies in order to define whether they can represent a real therapeutic alternative. In conclusion, available data are sufficient to state that the use of terlipressin plus albumin has really changed the management of HRS. Nevertheless, some crucial unsolved issues still exist, in particular: (a) how to predict nonresponse to treatment, (b) how to manage nonresponse to treatment and (c) how to consider the response in those patients who are candidates for liver transplant in the priority allocation process. (C) 2015 S. Karger AG, Basel