Afectación renal en la enfermedad hepática crónica avanzada. Síndrome hepatorrenal

  1. Ibáñez Samaniego, L. 1
  2. Baines, A. 1
  3. Bañares, R. 2
  1. 1 Servicio de Medicina del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
  2. 2 Servicio de Medicina del Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España Facultad de Medicina, Universidad Complutense, Madrid, España
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2023

Título del ejemplar: Enfermedades nefrourinarias (IV): El riñón en las enfermedades sistémicas. Síndrome hepatorrenal

Serie: 13

Número: 82

Páginas: 4841-4849

Tipo: Artículo

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Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

El desarrollo de insuficiencia renal ocurre con frecuencia en los pacientes con enfermedad hepática crónica avanzada (EHCA). Su aparición dificulta el tratamiento de las complicaciones de la hepatopatía y empeora su pronóstico. Si bien la causa más frecuente de insuficiencia renal en estos pacientes es la prerrenal, es importante sospechar la presencia de un síndrome hepatorrenal (AKI-HRS), ya que el diagnóstico y el tratamiento precoz han demostrado mejorar la supervivencia. El AKI-HRS es un trastorno funcional renal grave y potencialmente reversible, secundario a la disfunción circulatoria sistémica y esplácnica característica de los pacientes con cirrosis, hipertensión portal y ascitis. El diagnóstico del AKI-HRS debe sospecharse cuando el paciente no responde a las medidas iniciales y, además, cumple una serie de criterios diagnósticos específicos. El tratamiento del síndrome hepatorrenal se basa en la administración combinada de vasoconstrictores esplácnicos y albúmina por vía intravenosa. La terlipresina administrada en infusión continua es el vasoconstrictor más empleado. El desarrollo de AKI-HRS conlleva una elevada mortalidad, siendo el trasplante hepático el tratamiento definitivo, por lo que debe considerarse de forma individualizada en cada paciente.

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Fuente de los datos: Dialnet