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SM ISO690:2012 RABA, Tatiana. Sindromul hepatorenal la copii: probleme diagnostice şi terapeutice. In: Buletin de Perinatologie, 2017, nr. 1(73), pp. 76-81. ISSN 1810-5289. |
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Buletin de Perinatologie | |||||
Numărul 1(73) / 2017 / ISSN 1810-5289 | |||||
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Hepatorenal syndrome (HRS) is a functional, reversible form of acute kidney injury in patients with acute or chronic severe liver disease in the absence of any other identifiable causes of renal pathology. The condition is characterized by peripheral vasodilation with subsequent profound intrarenal vasoconstriction, resulting in decreased glomerular filtration. Renal vasoconstriction starts early in patients with liver disease, even before renal dysfunction is clinically evident. Hepatorenal syndrome is an exclusion diagnosis. Two types of HRS are described. Type 1 HRS is mainly associated with acute liver failure. It is characterized by rapid deterioration of renal function that usually occurs within 2 weeks, with an increase in serum creatinine and a substantial decrease in the glomerular filtration rate (GFR). Hyponatremia and other electrolyte abnormalities are common findings. Type 2 HRS has a more insidious onset and is characterized by a steady and progressive decline in the renal function over weeks and sometimes months, as well as recurrent, diuretic-resistant ascites. It generally occurs more often in patients with hepatic dysfunction less severe than that observed in type 1. Both type 1 and type 2 HRS are associated with a poor prognosis. Terlipressin, a vasopressin analogue, and albuminum 10% is the agent of choice for HRS therapy for children aimed at the promotion of intrahospital survival for the subsequent referral to liver transplantation. |
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