HEPATORENAL SYNDROME - 05/09/11
Résumé |
Patients with advanced cirrhosis and ascites often develop a peculiar form of renal failure in the absence of clinical, laboratory or histologic causes of renal dysfunction.12 This condition is known as hepatorenal syndrome (HRS). The functional origin of HRS was suggested when renal specimens from these patients showed minimal histologic changes and was further confirmed by studies showing that kidneys from cirrhotic patients with HRS regained a normal function when transplanted to patients with chronic renal failure and no liver disease, and that renal failure was reversible after liver transplantation.40, 43, 69 Subsequent investigations consistently demonstrated that hypoperfusion of the kidneys caused by marked renal vasoconstriction is the major mechanism underlying HRS.16 In the last two decades, a new pathophysiologic explanation of this syndrome has been proposed, linking the changes in systemic circulation and the activity of the endogenous vasoactive system that are characteristic of these patients to the development of renal hypoperfusion.12, 53 These advances have helped in the design of promising new therapeutic strategies in the management of HRS. This article reviews the pathogenesis, clinical features, and management of HRS in patients with cirrhosis.
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| Address reprint requests to Vincente Arroyo, MD, Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain, e-mail: arroyo@medicina.ub.es |
Vol 4 - N° 2
P. 487-507 - mai 2000 Retour au numéro
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- PATHOGENESIS OF HEPATIC ENCEPHALOPATHY
- E. Anthony Jones
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