肝肾综合征发生的危险因素、诊断和最新分型

Risk factors,diagnosis,and updated classification of hepatorenal syndrome

肝肾综合征(HRS)是肝硬化失代偿期的常见并发症,传统定义认为进行性少尿或无尿、氮质血症、稀释性低钠血症和低尿钠,而肾脏病理无明显器质性改变的肾功能不全是HRS的典型表现。新近研究发现,除血流动力学异常外,炎症反应、氧化应激及胆汁酸盐的直接肾小管毒性作用共同参与了HRS的发生、发展。HRS并非肝硬化患者的唯一肾脏并发症,其只是急性肾损伤(AKI)的一种功能形式。符合AKI的HRS称之为HRS-AKI,相当于既往的HRS-Ⅰ型。肝硬化患者出现急性肾病(AKD)和慢性肾病(CKD),如果符合HRS的标准,可诊断为HRS-NAKI,相当于既往的HRS-Ⅱ型。HRS的最常见危险因素是感染,消化道出血和大量放腹水后未输注人血白蛋白扩容。

Hepatorenal syndrome(HRS)is a common complication of decompensated cirrhosis and is traditionally defined as progressive oliguria or anuria,azotemia,dilutional hyponatremia,and hyponatremia,while renal insufficiency without marked organic lesions in the kidney is the typical manifestation of HRS.Recent studies have found that besides the abnormalities in hemodynamics,inflammatory response,oxidative stress,and direct renal tubular toxicity of bile salts are jointly involved in the development and progression of HRS.HRS is not the only renal complication in patients with liver cirrhosis,and it is only a functional form of acute kidney injury(AKI).HRS meeting the criteria for AKI is called HRS-AKI,which is formerly known as HRS-Ⅰtype.For cirrhotic patients with acute kidney disease or chronic kidney disease,if they meet the criteria for HRS,they can be diagnosed with HRS-NAKI,which is formerly known as HRS-Ⅱtype.The most common risk factors for HRS are infection,digestive bleeding,and large-volume paracentesis without transfusion of human serum albumin for volume expansion.