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 Printable version |
Acute renal failure in patients with cirrhosis |
Hépato-Gastro. Volume 15, Number 4, 267-73, Juillet-Août 2008, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Marika Rudler, Dominique Thabut |
Summary : Acute renal failure (ARF) is a severe complication of cirrhosis, with poor prognosis and various causes. Most ARF are related to prerenal failure, due either to true hypovolemia, or more rarely to hepatorenal syndrome, with or without ongoing infection. Nephrotoxic drugs or contrast medium can be responsible for renal hypoperfusion or for acute tubular necrosis. Initial evaluation must include blood and urinary tests and renal ultrasonography. Renal biopsy is generally not necessary. Main prognostic factors are the severity of cirrhosis and the presence of a systemic inflammatory response syndrome, with or without ongoing infection. Treatment depends on the aetiology of ARF. Nephrotoxic drugs should always be stopped. Liver transplantation is the optimal treatment of hepatorenal syndrome. The recommended symptomatic treatment is the association of terlipressin and albumin, which should be continued except when creatininemia does not decrease. In case of acute tubular necrosis, symptomatic treatment is needed, and renal-replacement therapy should be discussed. Prevention of ARF is essential. In patients with spontaneous bacterial peritonitis, intravenous albumin perfusion, in addition to antibiotics improves mortality as compared to antibiotics alone. Contrast medium-induced renal failure may be prevented with oral acetylcystein therapy. Nephrotoxic drugs like aminoglycosides and non-steroidal antiinflammatory drugs should always be avoided in cirrhotic patients. |
Keywords : cirrhosis, renal failure, inflammation, nephrotoxic agent |
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