Characteristics of Hepatorenal Syndrome分析课件.ppt

* Characteristics of Hepatorenal Syndrome Renal failure in patients with cirrhosis, advanced liver failure and severe sinusoidal portal hypertension Absence of significant histological changes in the kidney (“functional” renal failure) Marked arteriolar vasodilation in the extra-renal circulation Marked renal vasoconstriction leading to reduced glomerular filtration rate CHARACTERISTICS OF HEPATORENAL SYNDROME (HRS) Two Types of Hepatorenal Syndrome Type 1 Rapidly progressive renal failure (2 weeks) Doubling of creatinine to >2.5 or halving of creatinine clearance (CrCl) to <20 ml/min Type 2 More slowly progressive Creatinine >1.5 mg/dL or CrCl < 40 ml/min Associated with refractory ascites Arroyo et al., Hepatology 1996; 23:164 TYPES OF HEPATORENAL SYNDROME (HRS) SURVIVAL IN THE DIFFERENT TYPES OF HEPATORENAL SYNDROME (HRS) 0 2 4 6 8 12 10 Months 1 0.2 0.4 0.6 0.8 Survival probability 0 Type 2 p = 0.001 Survival in Different Types of Hepatorenal Syndrome (HRS) Gines et al., Lancet 2003; 362:1819 Type 1 Cirrhosis Intrahepatic resistance Sinusoidal pressure Arteriolar resistance (vasodilation) Effective arterial blood volume Ascites Sodium and water retention Activation of neurohumoral systems Renal vasoconstriction Renal dysfunction NSAIDs Diuretics Diarrhea Hemorrhage Vasodilators LVP w/o albumin Infection THERE ARE MANY CONDITIONS OTHER THAN HEPATORENAL SYNDROME THAT CAN LEAD TO RENAL FAILURE IN PATIENTS WITH CIRRHOSIS Cirrhosis Intrahepatic resistance Sinusoidal pressure Arteriolar resistance (vasodilation) Effective arterial blood volume Ascites Sodium and water retention Activation of neurohumoral systems Renal vasoconstriction Renal dysfunction NSAIDs Diuretics Diarrhea Hemorrhage Vasodilators LVP w/o albumin Infection Hepatorenal Syndrome HEPATORENAL SYNDROME (HRS) IS A DIAGNOSIS OF EXCLUSION Natural History of Hepatorenal Syndrome (HRS) Arroyo et al., Gastroenterology 2002; 122:1658 5 3 1 0 Months Creatinine (mg/dL) 6 0 - 4 0 1 3 4