We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Hepatorenal syndrome in children: a review.
- Authors
Liu, Priscila Menezes Ferri; de Carvalho, Sarah Tayná; Fradico, Pollyanna Faria; Cazumbá, Maria Luiza Barreto; Campos, Ramon Gustavo Bernardino; Simões e Silva, Ana Cristina
- Abstract
Hepatorenal syndrome (HRS) occurs in patients with cirrhosis or fulminant hepatic failure and is a kind of pre-renal failure due to intense reduction of kidney perfusion induced by severe hepatic injury. While other causes of pre-renal acute kidney injury (AKI) respond to fluid infusion, HRS does not. HRS incidence is 5% in children with chronic liver conditions before liver transplantation. Type 1 HRS is an acute and rapidly progressive form that often develops after a precipitating factor, including gastrointestinal bleeding or spontaneous bacterial peritonitis, while type 2 is considered a slowly progressive form of kidney failure that often occurs spontaneously in chronic ascites settings. HRS pathogenesis is multifactorial. Cirrhosis causes portal hypertension; therefore, stasis and release of vasodilator substances occur in the hepatic vascular bed, leading to vasodilatation of splanchnic arteries and systemic hypotension. Many mechanisms seem to work together to cause this imbalance: splanchnic vasodilatation; vasoactive mediators; hyperdynamic circulation states and subsequent cardiac dysfunction; neuro-hormonal mechanisms; changes in sympathetic nervous system, renin-angiotensin system, and vasopressin. In patients with AKI and cirrhosis, fluid expansion therapy needs to be initiated as soon as possible and nephrotoxic drugs discontinued. Once HRS is diagnosed, pharmacological treatment with vasoconstrictors, mainly terlipressin plus albumin, should be initiated. If there is no response, other options can include surgical venous shunts and kidney replacement therapy. In this regard, extracorporeal liver support can be a bridge for liver transplantation, which remains as the ideal treatment. Further studies are necessary to investigate early biomarkers and alternative treatments for HRS.
- Subjects
DISEASE progression; KIDNEYS; FLUID therapy; HEPATORENAL syndrome; CIRRHOSIS of the liver; LIVER diseases; VASODILATION; SYMPTOMS; HYPOTENSION; PORTAL hypertension; ACUTE kidney failure; DISEASE complications; CHILDREN; ADOLESCENCE
- Publication
Pediatric Nephrology, 2021, Vol 36, Issue 8, p2203
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-020-04762-6