慢加急性肝衰竭并发急性肾损伤的诊治进展

李小鹏; 吴振平; 张伦理; 李明

doi:10.3969/j.issn.1001-5256.2016.09.011

慢加急性肝衰竭并发急性肾损伤的诊治进展

DOI: 10.3969/j.issn.1001-5256.2016.09.011

南昌大学第一附属医院感染病科江西省肝脏再生医学重点实验室

基金项目:

江西省自然科学基金项目(20161BAB205254)；江西省科技支撑项目(20151BBG70229)；

详细信息

中图分类号: R575.3;R692
计量
- 文章访问数: 2474
- HTML全文浏览量: 33
- PDF下载量: 561
- 被引次数: 0
出版历程
- 出版日期: 2016-09-20

Advances in diagnosis and treatment of patients with acute-on-chronic liver failure complicated by acute kidney injury

Department of Infectious Diseases & Key Laboratory of Liver Regenerative Medicine of Jiangxi Province, The First Affiliated Hospital of Nanchang University

Research funding:

摘要

摘要: 慢加急性肝衰竭(ACLF)是国内最常见的肝衰竭类型,临床表现复杂,病死率高。ACLF并发急性肾损伤(AKI)时患者住院时间延长,多器官衰竭风险更高,常提示预后不良。简述了近年来ACLF并发AKI的定义、诱因、预后判断、诊断标志物、治疗等方面取得的进展,认为早期识别诊断AKI,并予以干预,有助于逆转肾损伤,避免发生重症AKI。
- 肝功能衰竭 /
- 肾功能不全,急性 /
- 诊断 /
- 治疗
Abstract: Acute- on- chronic liver failure( ACLF) is the most common type of liver failure in China,and it has complicated clinical manifestations and high mortality. When the patients experience ACLF complicated by acute kidney injury( AKI),they tend to have a prolonged length of hospital stay and a high risk of multiple organ failure,which always suggests poor prognosis. This article briefly describes the advances in the definition,causative factors,prognostic evaluation,diagnostic markers,and treatment of ACLF complicated by AKI. It is pointed out that early identification,diagnosis,and intervention of AKI helps to reverse kidney injury and avoid the development of severe AKI.
- liver failure /
- renal insufficiency,acute /
- diagnosis /
- therapy

HTML全文

参考文献(40)

[1] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA;Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,CMA.Guideline for diagnosis and treatment of liver failure[J].Chin J Clin Infect Dis,2012,5(6):321-327.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华临床感染病杂志,2012,5(6):321-327.

[2]THABUT D,MASSARD J,GANGLOFF A,et al.Model for endstage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure[J].Hepatology,2007,46(6):1872-1882.

[3] CHERTOW GM,BURDICK E,HONOUR M,et al.Acute kidney injury,mortality,length of stay,and costs in hospitalized patients[J].J Am Soc Nephrol,2005,16(11):3365-3370.

[4]MEHTA RL,KELLUM JA,SHAH SV,et al.Acute Kidney Injury Network:report of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):r31.

[5]KHWAJA A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.

[6]CAI JJ,HAN T,ZHOU J,et al.Comparison of different criteria to evaluate acute kidney injury and determine short-term prognosis of patients with acute-on-chronic liver failure[J].Chin J Hepatol,2015,23(9):684-687.(in Chinese)蔡均均,韩涛,周静,等.不同肾损伤标准在评估肝衰竭患者急性肾损伤发生率和病死率中的应用[J].中华肝脏病杂志,2015,23(9):684-687.

[7]ANGELI P,GINES P,WONG F,et al.Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites[J].Gut,2015,64(4):531-537.

[8]ARROYO V,TERRA C,GINS P.Advances in the pathogenesis and treatment of type-1 and type-2 hepatorenal syndrome[J].J Hepatol,2007,46(5):935-946.

[9]MAIWALL R,SARIN SK,MOREAU R.Acute kidney injury in acute on chronic liver failure[J].Hepatol Int,2016,10(2):245-257.

[10]BAJAJ JS,O'LEARY JG,WONG F,et al.Bacterial infections in end-stage liver disease:current challenges and future directions[J].Gut,2012,61(8):1219-1225.

[11]ZHANG LF,WANG JF.Anaysis of related factors of HBV-ACLF pateints occued AKI[J].Chin Hepatol,2015,20(8):606-609.(in Chinese)张玲芳,王介非.乙型肝炎相关慢加急性肝衰竭患者发生急性肾损伤的相关因素分析[J].肝脏,2015,20(8):606-609.

[12]GARCIA-TSAO G,PARIKH CR,VIOLA A.Acute kidney injury in cirrhosis[J].Hepatology,2008,48(6):2064-2077.

[13]HUANG Z,LIN C,FANG J,et al.Acute kidney injury in hepatitis B-related acute-on-chronic liver failure without preexisting liver cirrhosis[J].Hepatol Int,2015,9(3):416-423.

[14]GOMEZ-CASADO C,ROTH-WALTER F,JENSEN-JAROLIM E,et al.Modeling iron-catecholates binding to NGAL protein[J].J Mol Graph Model,2013,45:111-121.

[15]NGUYEN MT,DEVARAJAN P.Biomarkers for the early detection of acute kidney injury[J].Pediatr Nephrol,2008,23(12):2151-2157.

[16]ZHANG Y,XU QY,LIU XD,et al.The expression levels of the serum NGAL in the kidney after ischemia-reperfusion injury in rats[J].J Clin Exp Med,2014,13(3):165-168.(in Chinese)张燕,许清玉,刘向东,等.NGAL在大鼠肾脏缺血再灌注损伤不同阶段中的表达及意义[J].临床和实验医学杂志,2014,13(3):165-168.

[17]LUO JH,WU N,LI J.Significance of serum NGAL and KIM-1 levels in elderly patients with acute kidney injury undergoing continuous renel replacement therapy[J].Chin J Med Offic,2014,42(11):1118-1121.(in Chinese)罗俊华,吴娜,李娟.接受连续性肾脏替代治疗的老年急性肾损伤患者NGAL、KIM-1检测的意义[J].临床军医杂志,2014,42(11):1118-1121.

[18]FAGUNDES C,BARRETO R,GUEVARA M,et al.A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis[J].J Hepatol,2013,59(3):474-481.

[19]ICHIMURA T,BONVENTRE JV,BAILLY V,et al.Kidney injury molecule-1(KIM-1),a putative epithelial cell adhesion molecule containing a novel immunoglobulin domain,is up-regulated in renal cells after injury[J].J Biol Chem,1998,273(7):4135-4142.

[20]VAIDYA VS,RAMIREZ V,ICHIMURA T,et al.Urinary kidney injury molecule-1:a sensitive quantitative biomarker for early detection of kidney tubular injury[J].Am J Physiol Renal Physiol,2006,290(2):f517-f529.

[21]GAUER S,SICHLER O,OBERMLLER N,et al.IL-18 is expressed in the intercalated cell of human kidney[J].Kideny Int,2007,72(9):1081-1087.

[22]MANABE K,KAMIHATA H,MOTOHIRO M,et al.Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury[J].Eur J Clin Invest,2012,42(5):557-563.

[23]SUSANTITAPHONG P,SIRIBAMRUNGWONG M,DOI K,et al.Performance of urinary liver-type fatty acid-binding protein in acute kidney injury:a meta-analysis[J].Am J Kideny Dis,2013,61(3):430-439.

[24]PECO-ANTIC'A,IVANIEVIC'I,VULIC'EVIC'I,et al.Biomarkers of acute kidney injury in pediatric cardiac surgery[J].Clin Biochem,2013,46(13-14):1244-1251.

[25]WAN ZH,WANG JJ,XIE GM,et al.Significance of serum cystatin C level for early diagnosis of acute kidney injury in patients with acute-on-chronic liver failure[J].J Clin Hepatol,2014,30(7):666-669.(in Chinese).万志红,王建军,谢国明,等.血清胱抑素C对慢加急性肝衰竭患者肾损伤的早期诊断意义[J].临床肝胆病杂志,2014,30(7):666-669.

[26]STETLER-STEVENSON WG.Tissue inhibitors of metalloproteinases in cell signaling:metalloproteinase-independent biological activities[J].Sci Signal,2008,1(27):re6.

[27]MEERSCH M,SCHMIDT C,van AKEN H,et al.Urinary TIMP-2and IGFBP7 as early biomarkers of acute kidney injury and renal recovery following cardiac surgery[J].PLo S One,2014,9(3):e93460.

[28]GOCZE I,KOCH M,RENNER P,et al.Urinary biomarkers TIMP-2 and IGFBP7 early predict acute kidney injury after major surgery[J].PLo S One,2015,10(3):e0120863.

[29]JINDAL A,BHADORIA AS,MAIWALL R,et al.Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure[J].Liver Int,2016,36(1):59-67.

[30]JINDAL A,SARIN SK.Acute kidney injury(AKI)at admission and its response to terlipressin as a predictor of mortality in patients with acute-on-chronic liver failure(ACLF)[J].J Hepatol,2013,58(Suppl 1):s89.

[31]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397-417.

[32]BOYER TD,SANYAL AJ,GARCIA-TSAO G,et al.Predictors of response to terlipressin plus albumin in hepatorenal syndrome(HRS)type 1:relationship of serum creatinine to hemodynamics[J].J Hepatol,2011,55(2):315-321.

[33]ZHONG YB,ZHANG LL.Octreotide combined with albumin and furosemide in the treatment of hepatorenal syndrome[J].Chin Gen Pract,2012,15(4C):1350-1352.(in Chinese)钟渊斌,张伦理.奥曲肽联合清蛋白及呋塞米治疗肝肾综合征的临床疗效研究[J].中国全科医学杂志,2012,15(4C):1350-1352.

[34]SOURIANARAYANANE A,RAINA R,GARG G,et al.Management and outcome in hepatorenal syndrome:need for renal replacement therapy in non-transplanted patients[J].Int Urol Nephrol,2014,46(4):793-800.

[35]DAVENPORT A,WILL EJ,DAVISON AM.Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure[J].Kidney Int Suppl,1993,41:s245-s251.

[36]KOCH DG,FALLON MB.Hepatopulmonary syndrome[J].Clin Liver Dis,2014,18(2):407-420.

[37]ROSSLE M.TIPS:25 years later[J].J Hepatol,2013,59(5):1081-1093.

[38]POLSON J,LEE WM,American Association for the Study of Liver Disease.AASLD position paper:the management of acute liver failure[J].Hepatology,2005,41(5):1179-1197.

[39]CHAN AC,FAN ST,LO CM,et al.Liver transplantation for acute-on-chronic liver failure[J].Hepatol Int,2009,3(4):571-581.

[40]ANGELI P,GINES P.Hepatorenal syndrome,MELD score and liver transplantation:an evolving issue with relevant implications for clinical practice[J].J Hepatol,2012,57(5):1135-1140.

施引文献

资源附件(0)

访问统计