Hepatorenal Syndrome.
Albumins
Biomarkers
Early Diagnosis
Hepatorenal Syndrome
Inflammation
Kidney Tubular Necrosis, Acute
Liver Cirrhosis
Liver Transplantation
Lypressin
Prognosis
Renal Circulation
Vasoconstriction
Vasoconstrictor Agents
acute kidney injury
glomerular filtration rate
hepatorenal
kidney transplantation
liver transplantation
terlipressin
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 05 2019
07 05 2019
Historique:
pubmed:
19
4
2019
medline:
4
8
2020
entrez:
19
4
2019
Statut:
ppublish
Résumé
Hepatorenal syndrome is a severe complication of end-stage cirrhosis characterized by increased splanchnic blood flow, hyperdynamic state, a state of decreased central volume, activation of vasoconstrictor systems, and extreme kidney vasoconstriction leading to decreased GFR. The contribution of systemic inflammation, a key feature of cirrhosis, in the development of hepatorenal syndrome has been highlighted in recent years. The mechanisms by which systemic inflammation precipitates kidney circulatory changes during hepatorenal syndrome need to be clarified. Early diagnosis is central in the management and recent changes in the definition of hepatorenal syndrome help identify patients at an earlier stage. Vasoconstrictive agents (terlipressin in particular) and albumin are the first-line treatment option. Several controlled studies proved that terlipressin is effective at reversing hepatorenal syndrome and may improve short-term survival. Not all patients are responders, and even in responders, early mortality rates are very high in the absence of liver transplantation. Liver transplantation is the only curative treatment of hepatorenal syndrome. In the long term, patients transplanted with hepatorenal syndrome tend to have lower GFR compared with patients without hepatorenal syndrome. Differentiating hepatorenal syndrome from acute tubular necrosis (ATN) is often a challenging yet important step because vasoconstrictors are not justified for the treatment of ATN. Hepatorenal syndrome and ATN may be considered as a continuum rather than distinct entities. Emerging biomarkers may help differentiate these two conditions and provide prognostic information on kidney recovery after liver transplantation, and potentially affect the decision for simultaneous liver-kidney transplantation.
Identifiants
pubmed: 30996046
pii: 01277230-201905000-00024
doi: 10.2215/CJN.12451018
pmc: PMC6500947
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
774-781Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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