重新评估肾脏病患者TIPS的候选性。

IF 3 Q1 UROLOGY & NEPHROLOGY
Kidney360 Pub Date : 2025-09-26 DOI:10.34067/KID.0000001011
Megan M Griffin, Cary H Paine, Sarah F Sanghavi
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引用次数: 0

摘要

肝硬化患者由于门静脉高压引起的内脏血管扩张,导致有效动脉血容量下降,有肾功能障碍的危险。这可导致肝肾综合征,临床上表现为利尿剂难治性腹水、肌酐升高和低钠血症。经颈静脉肝内门静脉系统分流术(TIPS)是一种将血液直接从门静脉分流到肝静脉的手术,绕过肝硬化的高压系统。在利尿剂抵抗性腹水患者中,TIPS可减少腹水复发并改善肾功能。然而,由于通过肝窦的血液较少,TIPS的术后风险,包括肝性脑病和肝脏缺血的恶化,随着肝脏疾病的严重程度而增加。终末期肝病(MELD)评分模型使用INR、胆红素和血清肌酐作为变量来量化这种风险,并已用于从TIPS中排除高危患者。该方法的缺陷在于,虽然血清肌酐可以表明肝功能恶化,但它是该综合评分的一个参数,可以通过TIPS得到改善。本综述讨论了TIPS后发生的生理变化,并推荐了肾脏疾病患者选择TIPS的个体化方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Re-evaluating TIPS Candidacy for Patients with Kidney Disease.

Patients with cirrhosis of the liver are at risk for kidney dysfunction due to portal hypertension-induced splanchnic vasodilation, which results in a decrease in effective arterial blood volume. This can lead to hepatorenal syndrome, which may manifest clinically as ascites that is refractory to diuretics, a rise in creatinine, and hyponatremia. Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that shunts blood directly from the portal vein to the hepatic vein, bypassing the high-pressure system of the cirrhotic liver. Among patients with diuretic-resistant ascites, TIPS decreases recurrence of ascites and improves kidney function. However, since less blood is passing through the hepatic sinusoids, post-procedure risks of TIPS, including worsening hepatic encephalopathy and liver ischemia, increase with the severity of liver disease. The model for end-stage liver disease (MELD) score quantifies this risk using the INR, bilirubin, and serum creatinine as variables, and has been used to exclude high-risk patients from TIPS. The flaw in this method is that although serum creatinine can indicate worse hepatic function, it is a parameter of this composite score that may improve with TIPS. This review discusses the physiologic changes that occur after TIPS and recommends an individualized approach to TIPS selection in patients with kidney disease.

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来源期刊
Kidney360
Kidney360 UROLOGY & NEPHROLOGY-
CiteScore
3.90
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