characteristics of hepatorenal syndrome分析课件

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1、CharacteristicsofHepatorenalSyndromeRenalfailureinpatientswithcirrhosis,advancedliverfailureandseveresinusoidalportalhypertensionAbsenceofsignificanthistologicalchangesinthekidney(“functional”renalfailure)Markedarteriolarvasodilationintheextra-renalcirculationMarkedrenalvasoconstrictionleadingtored

2、ucedglomerularfiltrationrateCHARACTERISTICSOFHEPATORENALSYNDROME(HRS)TwoTypesofHepatorenalSyndromeType1Rapidlyprogressiverenalfailure(2weeks)Doublingofcreatinineto>2.5orhalvingofcreatinineclearance(CrCl)to<20ml/minType2MoreslowlyprogressiveCreatinine>1.5mg/dLorCrCl<40ml/minAssociatedwithrefractorya

3、scitesArroyoetal.,Hepatology1996;23:164TYPESOFHEPATORENALSYNDROME(HRS)SURVIVALINTHEDIFFERENTTYPESOFHEPATORENALSYNDROME(HRS)024681210Months10.20.40.60.8Survivalprobability0Type2p=0.001SurvivalinDifferentTypesofHepatorenalSyndrome(HRS)Ginesetal.,Lancet2003;362:1819Type1CirrhosisIntrahepaticresistance

4、SinusoidalpressureArteriolarresistance(vasodilation)EffectivearterialbloodvolumeAscitesSodiumandwaterretentionActivationofneurohumoralsystemsRenalvasoconstrictionRenaldysfunctionNSAIDsDiureticsDiarrheaHemorrhageVasodilatorsLVPw/oalbuminInfectionTHEREAREMANYCONDITIONSOTHERTHANHEPATORENALSYNDROMETHAT

5、CANLEADTORENALFAILUREINPATIENTSWITHCIRRHOSISCirrhosisIntrahepaticresistanceSinusoidalpressureArteriolarresistance(vasodilation)EffectivearterialbloodvolumeAscitesSodiumandwaterretentionActivationofneurohumoralsystemsRenalvasoconstrictionRenaldysfunctionNSAIDsDiureticsDiarrheaHemorrhageVasodilatorsL

6、VPw/oalbuminInfectionHepatorenalSyndromeHEPATORENALSYNDROME(HRS)ISADIAGNOSISOFEXCLUSIONNaturalHistoryofHepatorenalSyndrome(HRS)Arroyoetal.,Gastroenterology2002;122:16585310MonthsCreatinine(mg/dL)60-401342-6-22WeeksType2HRSType1HRSSBPCefotaximeTherapeuticparacentesesNATURALHISTORYOFHEPATORENALSYNDRO

7、ME(HRS)AdvancedhepaticfailureandportalhypertensionCreatinine>1.5mg/dLorcreatinineclearance<40ml/minAbsenceofshock,bacterialinfection,ornephrotoxicdrugsAbsenceofexcessivegastrointestinalorrenalfluidlossNoimp