O Dr. Mauricio de Carvalho, diretor científico da Sociedade Paranaense de Nefrologia, apresenta uma revisão sobre síndrome Hepatorenal. A apresentação é baseada em um artigo publicado no AJKD (2012), disponibilizado previamente em nosso site. Para acessar a aula clique em BAIXAR ANEXOS.
Síndrome Hepatorrenal: uma severa, mas tratável, causa de insuficiência renal em pacientes com cirrose.
Hepatorenal syndrome (HRS) is a unique type of kidney failure that occurs in advanced cirrhosis. It is characterized by functional impairment of the kidneys due to vasoconstriction of the renal arteries in the setting of preserved tubular function and absence of significant histologic abnormalities.
Renal vasoconstriction in HRS is due to severe vasodilation of the splanchnic arteries associated with portal hypertension, leading to a
decrease in effective arterial blood volume and arterial pressure. HRS commonly develops after a trigger, usually a bacterial infection, that disrupts the arterial circulation, but it also may occur spontaneously.
There are 2 forms of HRS: type 1 is characterized by an acute progressive decrease in kidney function and very short survival without treatment, whereas type 2 features stable less severe kidney failure and longer survival compared with type 1. A liver transplant is the preferred treatment for HRS. Pharmacologic treatment with vasoconstrictors to reverse splanchnic vasodilation, together with albumin, is effective in 40%-50% of patients
with type 1 HRS and improves survival. The drug of choice is the vasopressin analogue terlipressin. Renal replacement therapy should not be used as first-line therapy.
Am J Kidney Dis. 59(6):874-885. © 2012 by the National Kidney Foundation, Inc.
Clique em BAIXAR ANEXOS e tenha acesso ao artigo do AJKD.