Patogenia, diagnóstico y tratamiento de la disfunción renal en cirrosis
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https://doi.org/10.22516/25007440.39Palabras clave:
Insuficiencia renal aguda, infecciones, síndrome hepatorrenal, vasoconstrictores esplácnicos, albúminaResumen
Los pacientes con cirrosis hepática son susceptibles a presentar un deterioro de la función renal que puede ser de naturaleza funcional y/o estructural. La insuficiencia renal aguda (IRA) prerrenal representa la forma más frecuente en el 68% de los casos, e incluye un tipo especial de insuficiencia renal funcional conocida como síndrome hepatorrenal (SHR). La creatinina sérica permanece como el mejor biomarcador de IRA en cirrosis a pesar de sus reconocidas limitaciones. La diferenciación entre necrosis tubular aguda (NTA) y SHR se puede establecer con el uso de biomarcadores urinarios como la uNGAL. Los factores de riesgo de IRA en cirrosis incluyen las infecciones bacterianas, la hemorragia digestiva, las pérdidas de líquidos gastrointestinales y renales, la paracentesis sin albúmina y los agentes nefrotóxicos, entre otros. Los nuevos criterios por estadios de la AKI-IAC para el diagnóstico de IRA en cirrosis, que inician por un aumento de la creatinina sérica ≥0,3 mg/dL en menos de 48 horas, mejoran el pronóstico de los pacientes al permitir una intervención más temprana. El diagnóstico del SHR se establece al excluir las causas de azoemia prerrenal, NTA y expandir el volumen con albúmina. El uso de vasoconstrictores esplácnicos, como la terlipresina junto con la albúmina, permite revertir hasta el 40% de los casos de SHR. El trasplante hepático representa el tratamiento definitivo en pacientes con SHR.
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