MEDIX, God. 15 Br. 84/85  •  Pregledni članak  •  Interna medicina HR ENG

Hepatorenalni sindromHepatorenal syndrome

Milan Kujundžić, Tomislav Bokun

Hepatorenalni sindrom (HRS) predstavlja funkcionalno zatajenje bubrega kod bolesnika s uznapredovalom jetrenom bolešću u odsutnosti morfoloških oštećenja bubrega. Klinički je moguće razlikovati dva tipa HRS-a: tip 1 i tip 2. HRS će se najčešće razviti u bolesnika s uznapredovalom kroničnom jetrenom bolešću i precipitirajućim faktorima (spontani bakterijski peritonitis, krvarenje iz gastrointestinalnog trakta, preagresivna diuretska terapija, pretjerana terapijska paracenteza, uzimanje nesteroidnih protuupalnih lijekova i aminoglikozida). Iako se istražuje više terapijskih shema (kombinacije sistemskih vazokonstriktora i albumina), nažalost niti jedna ne obećava mnogo. Osnovu zbrinjavanja HRS-a i dalje čini kvalitetna prevencija i energično liječenje komplikacija te transplantacija jetre kao jedina efikasna terapija. 

Ključne riječi:
ascites; ciroza jetre; hepatorenalni sindrom; peritonitis; zatajenje jetre

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Hepatorenal syndrome (HRS) is a functional renal failure occurring in patients with advanced chronic liver disease in the absence of intrinsic renal disease. There are two clinical types of hepatorenal syndrome, type 1 and type 2, which differ in severity and speed of onset. Hepatorenal syndrome occurs in patients with advanced liver disease and ascites and is usually associated with spontaneous bacterial peritonitis, gastrointestinal bleeding, progressive diuretic treatment or excessive therapeutic paracentesis, and treatment with aminoglicosides and non-steroidal anti-inflammatory drugs. Different pharmacological approaches in the treatment of hepatorenal syndrome have been tested in clinical setting during the previous decade, but none showed a noticable clinical efficacy. Management of the syndrome is still focused on the prevention and treatment of complications of chronic liver diseases and liver transplantation remains the only effective treatment. 

Key words:
ascites; hepatorenal syndrome; liver cirrhosis; liver failure; peritonitis