Understanding and Treating Hepatorenal Syndrome: Insights from Recent Research.

IF 3.7 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Seminars in liver disease Pub Date : 2025-09-01 Epub Date: 2025-04-01 DOI:10.1055/a-2570-3330
Yuli Song, Xiaochen Yang, Chengbo Yu
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Abstract

Acute kidney injury (AKI) is a critical and often fatal complication in decompensated cirrhosis, significantly affecting inpatient survival rates. Hepatorenal syndrome (HRS), a distinct subtype of AKI, develops in individuals with advanced cirrhosis and portal hypertension. It is marked by progressive kidney dysfunction, poor prognosis, and frequently causes death before liver transplantation. The pathogenesis of HRS involves vasodilation of the splanchnic vessels, leading to overactivation of the endogenous vasoactive systems, circulatory dysfunction, and reduced renal perfusion, which ultimately impairs glomerular filtration. Recent studies have highlighted the role of systemic inflammation in exacerbating renal damage. Despite these changes, renal histology in HRS usually shows no significant abnormalities, and there is typically no hematuria, proteinuria, or abnormal findings on ultrasound. Common risk factors for HRS include spontaneous bacterial peritonitis, infections, and large-volume paracentesis without albumin infusion. Diagnosing HRS is challenging, particularly in distinguishing it from acute tubular necrosis, due to the absence of specific biomarkers. Treatment primarily involves vasoconstrictors such as terlipressin and albumin, with liver transplantation being the definitive therapeutic option. This review provides an updated understanding of HRS, addressing its pathophysiology, diagnosis, management, and future challenges, based on recent expert consensus.

理解和治疗肝肾综合征:来自最近研究的见解。
急性肾损伤(AKI)是失代偿期肝硬化的一个重要且常常致命的并发症,显著影响住院患者的生存率。肝肾综合征(HRS)是AKI的一种不同亚型,在晚期肝硬化和门静脉高压症患者中发展。其特点是进行性肾功能不全,预后差,常导致肝移植前死亡。HRS的发病机制涉及内脏血管的血管扩张,导致内源性血管活性系统过度激活,循环功能障碍,肾灌注减少,最终损害肾小球滤过。最近的研究强调了全身性炎症在加重肾损害中的作用。尽管有这些变化,HRS患者的肾脏组织学通常没有明显异常,通常没有血尿、蛋白尿或超声异常。HRS的常见危险因素包括自发性细菌性腹膜炎、感染和无白蛋白输注的大容量穿刺。由于缺乏特定的生物标志物,诊断HRS具有挑战性,特别是在将其与急性肾小管坏死(ATN)区分开来。治疗主要包括血管收缩剂,如特利加压素和白蛋白,肝移植是最终的治疗选择。这篇综述提供了对HRS的最新理解,阐述了其病理生理、诊断、管理和未来的挑战,基于最近的专家共识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Seminars in liver disease
Seminars in liver disease 医学-胃肠肝病学
CiteScore
8.20
自引率
2.40%
发文量
38
期刊介绍: Seminars in Liver Disease is a quarterly review journal that publishes issues related to the specialties of hepatology and gastroenterology. As the premiere review journal in the field, Seminars in Liver Disease provides in-depth coverage with articles and issues focusing on topics such as cirrhosis, transplantation, vascular and coagulation disorders, cytokines, hepatitis B & C, Nonalcoholic Steatosis Syndromes (NASH), pediatric liver diseases, hepatic stem cells, porphyrias as well as a myriad of other diseases related to the liver. Attention is also given to the latest developments in drug therapy along with treatment and current management techniques. Seminars in Liver Disease publishes commissioned reviews. Unsolicited reviews of an exceptional nature or original articles presenting remarkable results will be considered, but case reports will not be published.
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