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Intensivmedizin up2date 2010; 6(1): 41-52
DOI: 10.1055/s-0029-1243820
Internistische Intensivmedizin

© Georg Thieme Verlag KG Stuttgart · New York

Das hepatorenale Syndrom

Christine  Kurschat, Franziska  Grundmann, Thomas  Benzing
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Publication History

Publication Date:
09 February 2010 (online)

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Kernaussagen

  • Eine Nierenfunktionseinschränkung im Sinne des HRS reduziert das Überleben der Patienten mit Leberzirrhose und Aszites erheblich und sollte daher frühzeitig erkannt und adäquat therapiert werden.

  • Das HRS ist ein funktionelles, prinzipiell reversibles Nierenversagen.

  • Von allen Komplikationen bei Leberzirrhose stellt das HRS die Komplikation mit der kürzesten medianen Überlebensdauer dar.

  • HRS Typ 1: rasch fortschreitendes Nierenversagen, schlechte Prognose.

  • HRS Typ 2: langsamer fortschreitendes Nierenversagen und therapierefraktärer Aszites, etwas bessere Prognose.

  • Die Diagnose eines HRS erfordert den Ausschluss anderer Gründe für ein Nierenversagen wie akute Tubulusnekrose, Glomerulonephritis oder Volumendepletion.

  • Therapie der Wahl: Lebertransplantation.

  • Das Serumkreatinin vor der Lebertransplantation gilt als starker Prädiktor für das Überleben nach Lebertransplantation.

Literatur

  • 1 Salerno F, Gerbes A, Gines P. et al . Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.  Gut. 2007;  56 1310-1318
    CrossrefPubMedSearch in Google Scholar
  • 2 Gines A, Escorsell A, Gines P. et al . Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites.  Gastroenterology. 1993;  105 229-236
    CrossrefPubMedSearch in Google Scholar
  • 3 Alessandria C, Ozdogan O, Guevara M. et al . MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation.  Hepatology. 2005;  41 1282-1289
    CrossrefPubMedSearch in Google Scholar
  • 4 Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome.  Semin Liver Dis. 2008;  28 81-95
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Terra C, Guevara M, Torre A. et al . Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: value of MELD score.  Gastroenterology. 2005;  129 1944-1953
    CrossrefPubMedSearch in Google Scholar
  • 6 Fasolato S, Angeli P, Dallagnese L. et al . Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features.  Hepatology. 2007;  45 223-229
    CrossrefPubMedSearch in Google Scholar
  • 7 Follo A, Llovet J M, Navasa M. et al . Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis.  Hepatology. 1994;  20 1495-1501
    CrossrefPubMedSearch in Google Scholar
  • 8 Toledo C, Salmeron J M, Rimola A. et al . Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime.  Hepatology. 1993;  17 251-257
    CrossrefPubMedSearch in Google Scholar
  • 9 Garcia-Tsao G, Parikh C R, Viola A. Acute kidney injury in cirrhosis.  Hepatology. 2008;  48 2064-2077
    CrossrefPubMedSearch in Google Scholar
  • 10 Angeli P, Albino G, Carraro P. et al . Cirrhosis and muscle cramps: evidence of a causal relationship.  Hepatology. 1996;  23 264-273
    CrossrefPubMedSearch in Google Scholar
  • 11 Schrier R W, Arroyo V, Bernardi M. et al . Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis.  Hepatology. 1988;  8 1151-1157
    CrossrefPubMedSearch in Google Scholar
  • 12 Ruiz-del-Arbol L, Monescillo A, Arocena C. et al . Circulatory function and hepatorenal syndrome in cirrhosis.  Hepatology. 2005;  42 439-447
    CrossrefPubMedSearch in Google Scholar
  • 13 Ruiz-del-Arbol L, Urman J, Fernandez J. et al . Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis.  Hepatology. 2003;  38 1210-1218
    CrossrefPubMedSearch in Google Scholar
  • 14 Wiest R, Groszmann R J. Nitric oxide and portal hypertension: its role in the regulation of intrahepatic and splanchnic vascular resistance.  Semin Liver Dis. 1999;  19 411-426
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Gerbes A L, Gulberg V. [Hepatorenal syndrome].  Dtsch Med Wochenschr. 2003;  128 Suppl 2 S93-S95
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Caregaro L, Menon F, Angeli P. et al . Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis.  Arch Intern Med. 1994;  154 201-205
    CrossrefPubMedSearch in Google Scholar
  • 17 Ruiz R, Kunitake H, Wilkinson A H. et al . Long-term analysis of combined liver and kidney transplantation at a single center.  Arch Surg. 2006;  141 735-741; discussion 741 – 732
    CrossrefPubMedSearch in Google Scholar
  • 18 Marik P E, Wood K, Starzl T E. The course of type 1 hepato-renal syndrome post liver transplantation.  Nephrol Dial Transplant. 2006;  21 478-482
    CrossrefPubMedSearch in Google Scholar
  • 19 Gines P, Torre A, Terra C, Guevara M. Review article: pharmacological treatment of hepatorenal syndrome.  Aliment Pharmacol Ther. 2004;  20 Suppl 3 57-62; discussion 63 – 54
    PubMedSearch in Google Scholar
  • 20 Brensing K A, Textor J, Perz J. et al . Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study.  Gut. 2000;  47 288-295
    CrossrefPubMedSearch in Google Scholar
  • 21 Alessandria C, Ottobrelli A, Debernardi-Venon W. et al . Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study.  J Hepatol. 2007;  47 499-505
    CrossrefPubMedSearch in Google Scholar
  • 22 Sen S, Davies N A, Mookerjee R P. et al . Pathophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized controlled study.  Liver Transpl. 2004;  10 1109-1119
    CrossrefPubMedSearch in Google Scholar
  • 23 Mitzner S R, Stange J, Klammt S. et al . Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial.  Liver Transpl. 2000;  6 277-286
    CrossrefPubMedSearch in Google Scholar
  • 24 Stange J, Ramlow W, Mitzner S. et al . Dialysis against a recycled albumin solution enables the removal of albumin-bound toxins.  Artif Organs. 1993;  17 809-813
    CrossrefPubMedSearch in Google Scholar
  • 25 Sola-Vera J, Minana J, Ricart E. et al . Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites.  Hepatology. 2003;  37 1147-1153
    CrossrefPubMedSearch in Google Scholar
  • 26 Gines A, Fernandez-Esparrach G, Monescillo A. et al . Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis.  Gastroenterology. 1996;  111 1002-1010
    CrossrefPubMedSearch in Google Scholar
  • 27 Sort P, Navasa M, Arroyo V. et al . Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.  N Engl J Med. 1999;  341 403-409
    CrossrefPubMedSearch in Google Scholar
  • 28 Fernandez J, Monteagudo J, Bargallo X. et al . A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis.  Hepatology. 2005;  42 627-634
    CrossrefPubMedSearch in Google Scholar
  • 29 Fernandez J, Navasa M, Planas R. et al . Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis.  Gastroenterology. 2007;  133 818-824
    CrossrefPubMedSearch in Google Scholar

PD Dr. Christine Kurschat

Klinik IV für Innere Medizin, Nephrologie und Allgemeine Innere Medizin
Universitätsklinik Köln

Kerpener Str. 62
50937 Köln

Phone: 0221/478-89032

Fax: 0221/478-89041

Email: christine.kurschat@uk-koeln.de