Sepsis-induced acute kidney injury in patients with cirrhosis

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• 作者：Paolo Angeli ; Marta Tonon ; Chiara Pilutti ; Filippo Morando…
• 关键词：Acute kidney injury ; Hepatorenal syndrome ; Acute on chronic liver failure ; Albumin ; Terlipressin ; Sepsis ; Bacterial infections ; Biomarkers
• 刊名：Hepatology International
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：10
• 期：1
• 页码：115-123
• 全文大小：839 KB
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• 作者单位：Paolo Angeli (1)
  Marta Tonon (1)
  Chiara Pilutti (1)
  Filippo Morando (1)
  Salvatore Piano (1)
  
  1. Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
  
• 刊物主题：Hepatology; Colorectal Surgery; Surgery;
• 出版者：Springer India
• ISSN：1936-0541

文摘

Acute kidney injury (AKI) is a common and life-threatening complication in patients with cirrhosis. Recently, new criteria for the diagnosis of AKI have been proposed in patients with cirrhosis by the International Club of Ascites. Almost all types of bacterial infections can induce AKI in patients with cirrhosis representing its most common precipitating event. The bacterial infection-induced AKI usually meets the diagnostic criteria of hepatorenal syndrome (HRS). Well in keeping with the “splanchnic arterial vasodilation hypothesis”, it has been stated that HRS develops as a consequence of a severe reduction of effective circulating volume related to splanchnic arterial vasodilation and to an inadequate cardiac output. Nevertheless, the role of bacterial infections in precipitating organ failures, including renal failure, is enhanced when their course is characterized by the development of a systemic inflammatory response syndrome (SIRS), thus, when sepsis occurs. Sepsis has been shown to be capable to induce “per se” AKI in animals as well as in patients conditioning also the features of renal damage. This observation suggests that when precipitated by sepsis, the pathogenesis and the clinical course of AKI also in patients with cirrhosis may differentiate to a certain extent from AKI with another or no precipitating factor. The purpose of this review is to describe the features of AKI precipitated by bacterial infections and to highlight whether infection and/or the development of SIRS may influence its clinical course, and, in particular, the response to treatment.