Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- cirrose avançada
- icterícia
- ascite
Outros fatores diagnósticos
- diminuição moderada da pressão arterial (PA)
- edema periférico
- esplenomegalia
- aranha vascular
- oligúria
- hematomas
- petéquias
- eritema palmar
- marcas de arranhões
- ginecomastia
- encefalopatia
- prurido
- confusão
- torpor
Fatores de risco
- cirrose avançada
- ascite
- hepatite relacionada ao álcool
- hiponatremia
- atividade de renina plasmática (ARP) elevada
- peritonite bacteriana espontânea
- paracentese de grande volume
- sangramento gastrointestinal agudo
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- creatinina sérica
- ureia
- eletrólitos
- Hemograma completo
- testes hepáticos
- exame de coagulação
- paracentese diagnóstica e cultura de líquido ascítico
- hemocultura
- urinálise e cultura
- Radiografia torácica
Investigações a serem consideradas
- ultrassonografia renal
Algoritmo de tratamento
peritonite bacteriana espontânea (PBE): prevenção da síndrome hepatorrenal (SHR)
suspeita de SHR-LRA
SHR-LRA confirmada
Colaboradores
Autores
Douglas A. Simonetto, MD
Associate Professor of Medicine
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
Declarações
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
Declarações
KAS declares that she has no competing interests.
Agradecimentos
Dr Douglas A. Simonetto and Dr Kathryn A. Schmidt would like to gratefully acknowledge Dr John Kepros, the previous contributor to this topic.
Declarações
JK declares that he has no competing interests.
Revisores
William Carey, MD, MACG, FAASLD
Hepatology Section Head
Cleveland Clinic
Cleveland
OH
Disclosures
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.
References
Key articles
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.Full text Abstract
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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