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Hepatorenales Syndrom

Hepatorenal syndrome

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Zusammenfassung

Das hepatorenale Syndrom (HRS) umschreibt ein Nierenversagen, das bei Patienten mit fortgeschrittener Leberzirrhose im Zusammenhang mit einer Beeinträchtigung der systemischen Zirkulation auftritt. Die Inzidenz des HRS beträgt bei Patienten mit Aszites 8 %; die Gesamthäufigkeit des Nierenversagens beträgt in der Endphase des Leberversagens 75 %. Als ursächlich wird ein Fortschreiten der bei Lebererkrankungen auftretenden arteriellen Vasodilatation im Splanchnikusstromgebiet zusammen mit einer Verringerung des Herzzeitvolumens (HZV) angesehen. Es existieren 2 Typen des HRS: Beim HRS-Typ 1 kommt es zu einem schnellen Nierenversagen, das oftmals im Zusammenhang einer spontan-bakteriellen Peritonitis (SBP) auftritt und zügig in ein Multiorganversagen übergehen kann. Der HRS-Typ 2 ist durch eine langsame Entwicklung des Nierenversagens, zusammen mit der Zunahme des Aszites, gekennzeichnet. Die Prognose ist beim HRS-Typ 1 am schlechtesten. Die vorhandenen Therapieoptionen beim HRS (u. a. Gabe von Vasokonstriktoren und Albumin, Anlage eines transjugulären intrahepatischen Shunt, TIPS) können die Überlebensrate nur teilweise verbessern; die einzige definitive Behandlung stellt die Lebertransplantation dar.

Abstract

Hepatorenal syndrome (HRS) is a unique form of acute renal failure occurring in patients with advanced cirrhosis or acute liver failure. In patients with ascites the incidence of HRS is 8 % and in end-stage liver disease 75 % of patients suffer from HRS. Vasodilation of splanchnic arteries with subsequent decrease of effective blood volume, arterial pressure and renal vasoconstriction is hypothesized to be the central pathophysiological mechanism leading to acute renal failure. Moreover, cardiac output might be decreased in advanced cirrhosis. There are two types of HRS: while HRS type 1 is characterized by a rapid progression to acute renal failure often triggered by a precipitating event, e. g. bacterial peritonitis, which can rapidly develop into multiorgan failure, HRS type 2 shows a more steadily or slowly progressive course to renal failure with increasing ascites. Type 1 HRS has the worst prognosis. Treatment options include pharmacological treatment with vasoconstrictors and albumin and placement of transjugular intrahepatic portosystemic shunts (TIPS) but can only partially improve the survival rate. Liver transplantation is the ultimate and only definitive treatment of patients with HRS.

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  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    G. Huschak, U.X. Kaisers &  S. Laudi

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  1. G. Huschak
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  2. U.X. Kaisers
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  3. S. Laudi
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Correspondence to S. Laudi.

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Huschak, G., Kaisers, U. & Laudi, S. Hepatorenales Syndrom. Anaesthesist 62, 571–582 (2013). https://doi.org/10.1007/s00101-013-2197-3

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