肝硬化患者肾功能异常诊断标准的演变
Chinese Journal of Integrated Traditional and Western Nephrology(2018)
Abstract
由原发性肝脏疾病引起的肾功能异常临床上较为常见,主要包括结构异常的肾脏疾病,或没有显著组织病理学改变的肾功能异常,如肝肾综合征(hepatorenal syndrome,HRS)等.既往的认识只局限于HRS,随着认识的不断深入,急性肾损伤(acute kidney injury,AKI)已经取代急性肾功能衰竭(acute renal failure,ARF)的概念,AKI只要血肌酐轻微增加(≥0.3 mg/dl或超过基线水平≥50%)即可诊断,但AKI很难鉴别功能性ARF与急性肾小管坏死,且与肾组织学、临床特点和预后相关性差.有学者将AKI的概念延伸到失代偿性肝硬化患者,住院的肝硬化患者AKI的发病率约19%[1],AKI最常见的病因为肾前性,占68%[2],主要继发于感染、容量不足、血管扩张剂的使用等,HRS占肾前性AKI的25%,急性肾小管坏死(acute tubular necrosis,ATN)占AKI的32%,肾后性因素仅占1%.所有肝硬化患者慢性肾脏病(chronic kidney disease,CKD)的发生率约为1%[3].本文就肝硬化患者肾功能异常传统的诊断标准,AKI标准,及其他诊断分类标准做一综述.
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