Hepatorenal syndrome in children: a review
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REVIEW
Hepatorenal syndrome in children: a review Priscila Menezes Ferri Liu 1 & Sarah Tayná de Carvalho 1 & Pollyanna Faria Fradico 1 & Maria Luiza Barreto Cazumbá 1 & Ramon Gustavo Bernardino Campos 1 & Ana Cristina Simões e Silva 1 Received: 12 June 2020 / Revised: 1 August 2020 / Accepted: 5 September 2020 # IPNA 2020
Abstract Hepatorenal syndrome (HRS) occurs in patients with cirrhosis or fulminant hepatic failure and is a kind of pre-renal failure due to intense reduction of kidney perfusion induced by severe hepatic injury. While other causes of pre-renal acute kidney injury (AKI) respond to fluid infusion, HRS does not. HRS incidence is 5% in children with chronic liver conditions before liver transplantation. Type 1 HRS is an acute and rapidly progressive form that often develops after a precipitating factor, including gastrointestinal bleeding or spontaneous bacterial peritonitis, while type 2 is considered a slowly progressive form of kidney failure that often occurs spontaneously in chronic ascites settings. HRS pathogenesis is multifactorial. Cirrhosis causes portal hypertension; therefore, stasis and release of vasodilator substances occur in the hepatic vascular bed, leading to vasodilatation of splanchnic arteries and systemic hypotension. Many mechanisms seem to work together to cause this imbalance: splanchnic vasodilatation; vasoactive mediators; hyperdynamic circulation states and subsequent cardiac dysfunction; neuro-hormonal mechanisms; changes in sympathetic nervous system, renin-angiotensin system, and vasopressin. In patients with AKI and cirrhosis, fluid expansion therapy needs to be initiated as soon as possible and nephrotoxic drugs discontinued. Once HRS is diagnosed, pharmacological treatment with vasoconstrictors, mainly terlipressin plus albumin, should be initiated. If there is no response, other options can include surgical venous shunts and kidney replacement therapy. In this regard, extracorporeal liver support can be a bridge for liver transplantation, which remains as the ideal treatment. Further studies are necessary to investigate early biomarkers and alternative treatments for HRS. Keywords Hepatorenal syndrome . Physiopathology . Type 1 hepatorenal syndrome . Type 2 hepatorenal syndrome . Treatment . Hepatic failure . Liver transplant
Introduction Treatment of children and adolescents with chronic hepatic conditions is a real challenge. Many situations can make this challenge even bigger, and the hepatorenal syndrome (HRS) is one of them. Hepatorenal syndrome occurs in patients with cirrhosis or fulminant hepatic failure and is a kind of pre-renal failure due to intense reduction of kidney perfusion induced by increasingly severe hepatic injury. HRS is considered a Sarah Tayná de Carvalho, Pollyanna Faria Fradico, Maria Luiza Barreto Cazumbá and Ramon Gustavo Bernardino Campos contributed equally to this work. * Ana Cristina Simões e Silva [email protected] 1
Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerai
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