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- Title
Hepatorenal syndrome type 2: a frequently missed diagnosis.
- Authors
Dražilová, Sylvia; Skladaný, Ľubomír; Janičko, Martin; Jarčuška, Peter
- Abstract
The change in the view of hepatorenal syndrome (HRS) pathogenesis and implementation of the acute kidney injury (AKI) classification when evaluating renal damage in patients with liver cirrhosis led to a change in HRS classification. In the recently revised International Club of Ascites (ICA) classification, type 2 HRS includes "renal impairment which fulfills the criteria of HRS but not of AKI, namely non-AKI-HRS (NAKI) and only HRS-CKD as previously proposed". The theory of peripheral vasodilatation, which was historically accepted as the key factor in the HRS pathogenesis, was replaced by the theory of a systemic inflammatory response. The inflammation is the result of the bacterial translocation. The following production of the inflammatory cytokines leads to splanchnic vasodilatation and circulatory dysfunction. The cirrhotic cardiomyopathy plays an important role in the pathogenesis too. HRS-NAKI typically develops in patients with refractory ascites. The treatment of the refractory ascites and HRS-NAKI is identical. It involves large-volume paracentesis with administration of albumin, transjugular intrahepatic portosystemic shunt insertion and liver transplantation. There are only currently limited data for the use of automated low-flow ascites pumps. The renal condition in patients with HRS-NAKI improves after administration of splanchnic vasoconstrictors, but with a 50% relapse rate after treatment completion; therefore this treatment is not recommended. The prognosis of patients with HRS-NAKI is much better than that of patients with HRS-AKI.
- Subjects
HEPATORENAL syndrome; CIRRHOSIS of the liver; CHROMOSOMAL translocation; CYTOKINES; TRANSPLANTATION of organs, tissues, etc.
- Publication
Clinical & Experimental Hepatology, 2019, Vol 5, Issue 3, ps8
- ISSN
2392-1099
- Publication type
Article
- DOI
10.5114/ceh.2019.85162