par Gustot, Thierry 
Editeur scientifique Gustot, Thierry;Moreau, R.;Gerbes, Alexander L.
Référence Ascites, Hyponatremia and Hepatorenal Syndrome, Progress in Treatment, Basel, page (112-121)
Publication Publié, 2010
Editeur scientifique Gustot, Thierry
;Moreau, R.;Gerbes, Alexander L.Référence Ascites, Hyponatremia and Hepatorenal Syndrome, Progress in Treatment, Basel, page (112-121)
Publication Publié, 2010
Partie d'ouvrage collectif
| Résumé : | In patients with cirrhosis, acute kidney injury (AKI) is mainly due to prerenal factors (including type 1 hepatorenal syndrome; HRS) and ischemic acute tubular necrosis (ATN). Patients with cirrhosis may also develop chronic kidney disease (CKD) due to type 2 HRS, IgA nephropathy, hepatitis C virusrelated membranoproliferative glomerulonephritis, hepatitis B- related membranous glomerulopathy, diabetic nephropathy, nondiabetic glomerulosclerosis and ischemic nephropathy. Some patients have 'acute- on- chronic' kidney injury. In patients with cirrhosis and CKD waiting for liver transplantation, renal biopsy may be indicated because histopathological analysis of renal- biopsy specimens provides diagnostic and prognostic information. In these patients, the transjugular route can be safely used. Treatments of AKI should target the cause of renal hypoperfusion (e.g. fluid replacement to treat intravascular volume depletion; vasoconstrictor therapy for type 1 HRS). There is no specific treatment for ATN; renal- replacement therapy may be used. Treatments of CKD depend on the cause: there is no established therapy for type 2 HRS or IgA nephropathy; patients with chronic hepatitis C and membranoproliferative glomerulonephritis may benefit from antiviral therapy. Combined liver and kidney transplantation (CLKT) may be used in some patients with cirrhosis and CKD. The decision is based on the value of glomerular filtration rate (GFR) (ideally one should use measured and not estimated GFR) and the results of renal biopsy. |
