Role of endotoxemia in causing renal dysfunction in cirrhosis.
Role of endotoxemia in causing renal dysfunction in cirrhosis.
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DOI：
10.1136/jim-2019-001056
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发表时间：
2020-01
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影响因子：
--
通讯作者：
Liangpunsakul S
中科院分区：
文献类型：
--
作者：
Peng JL;Techasatian W;Hato T;Liangpunsakul S
肾衰竭对于肝硬化患者来说是一个具有挑战性的问题，因为死亡率随着肾功能恶化而增加，因此在计算肝移植评估的终末期肝病模型 (MELD) 评分时包含血清肌酐。在各种原因中，感染是肝硬化相关死亡的主要原因。细菌感染经常导致肝硬化患者出现肾功能衰竭，据报告患病率约为 34%。由于免疫力受损和肠道通透性增加导致门静脉高压症下细菌易位，肝硬化患者感染的风险增加。严重肝肾衰竭失代偿最可怕的并发症之一是肝肾综合征（HRS），肝移植可能是唯一可用的治疗方法。此外，在患有自发性细菌性腹膜炎（SBP）和尿路感染（UTI）的患者中，尽管感染得到缓解，但仍会发生进行性肾衰竭。因此，内毒素血症对肝硬化肾功能的影响已成为研究的重点。内毒素对肾功能损害的机制很复杂，但本质上涉及炎症失调、循环功能障碍、内毒素负荷清除不良以及血管运动性肾病。在本文中，我们将通过对肾血流量、肾血管内皮、肾小球滤过率（GFR）和肾小管功能的影响来回顾肝硬化时内毒素血症引起的肾功能障碍的机制。
Renal failure is a challenging problem in cirrhotic patients since mortality increases with worsening renal function, hence the inclusion of serum creatinine in calculating the Model for End-Stage Liver Disease (MELD) score for liver transplant evaluation. Among the various causes, infection is the leading etiology of mortality associated with cirrhosis. Bacterial infection frequently precipitates renal failure in patients with cirrhosis with the reported prevalence around 34%. Cirrhotic patients are at increased risk of infections due to impaired immunity and increased gut permeability leading to bacterial translocation in the setting of portal hypertension. One of the most feared complications of severely decompensated liver and renal failure is hepatorenal syndrome (HRS), of which liver transplant may be the only available treatment. Furthermore, in those with spontaneous bacterial peritonitis (SBP) and urinary tract infection (UTI), progressive renal failure occurs despite resolution of infection. Thus, the effects of endotoxemia on renal function in cirrhosis have become a major focus of research. The mechanisms of the damaging effects of endotoxin on renal function are complex but, in essence, involve dysregulated inflammation, circulatory dysfunction, poor clearance of endotoxin burden, as well as vasomotor nephropathy. In this article, we will review the mechanisms of endotoxemia-induced renal dysfunction in the setting of cirrhosis through the effects on renal blood flow, renal vascular endothelium, and glomerular filtration rate (GFR), and tubular function.
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影响因子：
24.5
作者：
Mencin A;Kluwe J;Schwabe RF
通讯作者：
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DOI：
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发表时间：
2006-05-01
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发表时间：
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