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肝肾综合征(HRS)系指严重肝病或急性重度肝损害患者在肝功能衰竭基础上所发生的特发性进行性肾前性肾功能衰竭,它是肝功能衰竭综合征的临床表现之一。其肾脏无原发疚患,肾脏的病理组织学无明显发现或仅有轻度非特异性改变。如果肝病获得改善,肾功能亦随之恢复正常。因此,HRS是严重肝病患者自发性或反应于肾血管循环改变而发生的肾功能不全,HRS的诊断需排除引起肾衰竭的其它原因。HRS常继发于各种类型的肝硬化失代偿期、暴发性肝衰竭、重型病毒性肝炎、原发或继发性肝癌及妊娠急性脂肪肝等严重肝痫。其特点为进行性少尿和氮质血症,但肾小管功能基本正常,尿钠低,尿渗透压/血浆渗透压之比〉1.1。HRS的持续和发展可转化为急性肾小管坏死(ATN),部分急性肝衰竭患者可不经HRS而直接发生ATN。临床上,无论是急性肝衰竭还是晚期肝硬化患者均常伴有HRS(发生率为42％～84％)。有报道称,死于肝昏迷的肝硬化和急性肝衰竭患者中分别有84％和73％伴有HRS。HRS患者预后不良,大多数近期内死于肝衰竭、胃肠道出血或感染,而肾功能衰竭本身并不是决定患者能存活多久的重要因素,真正死于尿毒症的HRS患者很少(低于11％)。
Hepatorenal syndrome (HRS) refers to idiopathic prerenal renal failure that occurs in patients with severe liver disease or acute severe liver damage on the basis of hepatic failure and is one of the clinical manifestations of liver failure syndrome . The kidneys did not have any guilt, and the pathology of the kidneys showed no or only mild nonspecific changes. If liver disease is improved, kidney function also returns to normal. Therefore, HRS is a renal insufficiency that occurs spontaneously or in response to changes in renal vascular circulation in patients with severe liver disease. HRS should be diagnosed to exclude other causes of renal failure. HRS often secondary to various types of decompensated liver cirrhosis, fulminant hepatic failure, severe viral hepatitis, primary or secondary liver cancer and acute fatty liver of pregnancy and other severe liver disease. Characterized by progressive oliguria and azotemia, but basically normal renal tubular function, low urinary sodium, urinary osmotic pressure / plasma osmolality ratio> 1.1. The persistence and development of HRS can translate into acute tubular necrosis (ATN), and some patients with acute liver failure can develop ATN directly without HRS. Clinically, both acute liver failure and advanced cirrhosis patients are often accompanied by HRS (the incidence rate of 42% to 84%). It has been reported that 84% and 73% of patients with cirrhosis and acute liver failure who die of hepatic coma, respectively, have HRS. HRS patients have a poor prognosis, most of whom die of liver failure, gastrointestinal bleeding or infection in the near future, whereas renal failure itself is not an important factor determining how long a patient can survive, and HRS patients who actually die of uremia are few 11%).