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肾脏病与透析肾移植杂志 ›› 2024, Vol. 33 ›› Issue (3): 269-274.DOI: 10.3969/j.issn.1006-298X.2024.03.014

• 危重肾脏病 • 上一篇    下一篇

肝肾综合征相关急性肾损伤发病机制研究及诊治进展

  

  • 出版日期:2024-06-28 发布日期:2024-06-26

Advances in pathogenesis,diagnosis and treatment of hepatorenal syndrome related acute kidney injury

  • Online:2024-06-28 Published:2024-06-26

摘要: 肝肾综合征(HRS)是一种有独特病理生理机制的肝硬化相关肾损害,其中,肝肾综合征相关急性肾损伤(HRS-AKI)是需要重点关注的亚型。除经典的血流动力学紊乱外,HRS-AKI的发病机制还涉及肠道细菌移位、系统性炎症、肾脏微循环障碍、肝硬化心肌病等。早期诊断和治疗可改善HRS-AKI预后,人血白蛋白联合特利加压素是目前广泛推荐的一线治疗,而肝移植是唯一的根治手段。本文就HRS-AKI新定义、诊断及分期标准、发病机制和诊治进展作一综述。


关键词: 晚期肝硬化, 肝肾综合征, 急性肾损伤, 人血白蛋白, 特利加压素

Abstract: Hepatorenal syndrome (HRS) is a type of cirrhosis-related renal damage with a unique pathophysiological mechanism. HRS-AKI is the subtype that needs special attention. In addition to the classical mechanisms of hemodynamic disorders,the occurrence of HRS-AKI also involves a variety of pathophysiological mechanisms such as intestinal bacterial translocation,systemic inflammation,renal microcirculation disorders and cirrhotic cardiomyopathy and so on. Early diagnosis and treatment can improve the poor prognosis of HRS-AKI. Albumin plus terlipressin is a widely recommended first-line treatment,nevertheless liver transplantation is the only definitive treatment for HRS. This article reviews the new definition,diagnostic and grading criteria,pathogenesis,and treatment of HRS-AKI.


Key words: advanced cirrhosis, hepatorenal syndrome, acute kidney injury, human albumin, terlipressin