Das hepatorenale Syndrom

Eine akute Nierenschädigung bei Patienten mit fortgeschrittener Lebererkrankung ist ein häufiges klinisches Problem. Die Prognose dieser Patienten ist erheblich eingeschränkt. Häufige Ursachen für eine Nierenfunktionsverschlechterung sind die prärenale Azotämie, die akute Tubulusnekrose oder das hepatorenale Syndrom. Die vom International Ascites Club 2015 publizierten neuen Empfehlungen zur Diagnose und Therapie der Nierenschädigung bei Patienten mit Leberzirrhose tragen dieser Heterogenität Rechnung. Zur Klassifizierung sollten nun die modifizierten KDIGO-Kriterien angewendet werden. Bei einem etablierten hepatorenalen Syndrom gilt die kombinierte Therapie mit Albumin und Terlipressin als Standard. Noradrenalin oder Midodrin sind mögliche Alternativen, falls Terlipressin nicht verfügbar ist. Die neuen Verfahren der Leberdialyse stellen eine hoffnungsvolle Option bei ausgewählten Patienten dar.

Acute kidney injury (AKI) in patients with chronic liver disease is a serious clinical problem associated with increased mortality. Different conditions such as simple prerenal azotemia, acute tubular necrosis or the hepatorenal syndrome may cause AKI in this setting. Therefore, the new recommendations published by the International Ascites Club 2015 introduced new algorithms for diagnosis and management of AKI. In summary, modified KDIGO criteria should be used to define AKI. In the case of an established hepatorenal syndrome, combined treatment with terlipressin/albumin has been proven effective in most of the published studies and should be regarded as the standard of care. Norepinephrine or midodrine are possible alternatives when terlipressin is not available. Extracorporeal liver support may be a promising option in selected patients.

Key words

acute kidney injury - hepatorenal syndrome - extracorporeal therapy

• Literatur

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