Hepatorenal syndrome: pathogenesis and novel pharmacological targets

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• 作者：Barada ; Kassem
• 关键词：AVP ; arginine vasopressin ; CI ; cardiac index ; GFR ; glomerular filtration rate ; HRS ; hepatorenal syndrome ; IHVR ; intrahepatic vascular resistance ; MAP ; mean arterial pressure ; NO ; nitric oxide ; PRA ; plasma renin activity ; RAAS ; renin angiotensin aldosteron
• 刊名：Current Opinion in Pharmacology
• 出版年：2004
• 出版时间：April, 2004
• 年：2004
• 卷：4
• 期：2
• 页码：189-197
• 全文大小：157 K

文摘

Hepatorenal syndrome is functional, reversible renal failure that occurs in patients with advanced liver cirrhosis or acute hepatic failure. The fundamental problem in hepatorenal syndrome is renal ischemia secondary to hypotension and profound renal cortical vasoconstriction. Sinusoidal hypertension and its associated splanchnic arterial vasodilatation initiate a cascade of events leading to activation of systemic and local vasoconstrictors and depletion of local renal vasodilators. Therapy with vasopressin V₁ receptor and α-adrenergic agonists, and plasma expanders, reverses type I and type II hepatorenal syndrome and improves survival. Large randomized, controlled, multicenter trials are needed to determine which drug is most effective, as well as the optimal dose and duration of treatment.