Hepatorenal syndrome
小结
定义
病史和体格检查
关键诊断因素
- advanced cirrhosis
- jaundice
- ascites
其他诊断因素
- moderate lowering of BP
- peripheral edema
- splenomegaly
- spider angioma
- oliguria
- bruising
- petechiae
- palmar erythema
- scratch marks
- gynecomastia
- encephalopathy
- pruritus
- confusion
- drowsiness
危险因素
- advanced cirrhosis
- ascites
- alcohol-related hepatitis
- hyponatremia
- high plasma renin activity (PRA)
- spontaneous bacterial peritonitis
- large volume paracentesis
- gastrointestinal (GI) bleeding
诊断性检查
首要检查
- serum creatinine
- BUN
- electrolytes
- CBC
- liver tests
- coagulation study
- diagnostic paracentesis and culture of ascitic fluid
- blood culture
- urinalysis and culture
- Chest x-ray
需考虑的检查
- renal ultrasound
治疗流程
spontaneous bacterial peritonitis (SBP): prevention of HRS
suspected HRS-AKI
confirmed HRS-AKI
撰稿人
作者
Douglas A. Simonetto, MD
Associate Professor of Medicine
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
利益声明
DAS has done consultancy work for Mallinckrodt, Evive, Resolution Therapeutics, and BioVie. DAS is an author of a reference cited in the topic.
Kathryn A. Schmidt, MD
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
利益声明
KAS declares that she has no competing interests.
鸣谢
Dr Douglas A. Simonetto and Dr Kathryn A. Schmidt would like to gratefully acknowledge Dr John Kepros, the previous contributor to this topic.
利益声明
JK declares that he has no competing interests.
同行评议者
William Carey, MD, MACG, FAASLD
Hepatology Section Head
Cleveland Clinic
Cleveland
OH
利益声明
WC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.全文 摘要
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687.全文 摘要
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.全文 摘要
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 Hepatol. 2010 Sep;53(3):397-417.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
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- Acute tubular necrosis - ischemic
- Acute tubular necrosis - nephrotoxic
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- Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome
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