慢加急性肝衰竭并发急性肾损伤诊疗进展*

doi:10.3969/j.issn.1672-5069.2025.05.040

Abstract

Abstract: Objective Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs after severe impairment of hepatic synthesis, detoxification, metabolism, and transformation functions, and can be complicated by multiple organ failure with a high morbidity and mortality rate. Hepatorenal syndrome (HRS) is one of the serious complications of ACLF, which is a special form of acute kidney injury (AKI) and an independent risk factor affecting the prognosis of patients with ACLF, and early diagnosis and treatment of AKI might effectively improve the prognosis of patients with ACLF.

Key words: Acute-on-chronic liver failure, Acute kidney injury, Hepatorenal syndrome

Du Bingyu, Li Junfeng, Zhang Liting. Early diagnosis and treatment of patients with acute-on-chronic liver failure complicated with acute kidney injury[J]. Journal of Practical Hepatology, 2025, 28(5): 797-800.

References

[1] Bajaj JS, O'leary JG, Lai JC, et al. Acute-on-chronic liver failure clinical guidelines. Am J Gastroenterol,2022,117(2):225-252.
[2] Angeli P, Ginès P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut,2015,64(4):531-537.
[3] Jiang W, Hu Y, Sun Y, et al. Prevalence and short-term outcome of acute kidney injury in patients with acute-on-chronic liver failure: A meta-analysis. J Viral Hepat,2020,27(8):810-817.
[4] Trebicka J, Fernandez J, Papp M, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol,2020,73(4):842-854.
[5] Zhao RH, Shi Y, Zhao H, et al. Acute-on-chronic liver failure in chronic hepatitis B: an update. Expert Rev Gastroenterol Hepatol,2018,12(4):341-350.
[6] Yang J, Nie QH, Wang AH, et al. Effects of intestinal intervention on bacterial translocation in a rat model of acute liver failure in vivo. Eur J Gastroenterol Hepatol,2010,22(11):1316-1322.
[7] Wang XL, Chen XJ, Ye HH, et al. Association of mRNA expression level of IP-10 in peripheral blood mononuclear cells with HBV-associated acute-on-chronic liver failure and its prognosis. J Huazhong Univ Sci Technolog Med Sci,2017,37(5):755-760.
[8] Solé C, Sola E, Huelin P, et al. Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival. Liver Int,2019,39(7):1246-1255.
[9] Lu J, Lin L, Ye C, et al. Serum NGAL is superior to cystatin C in predicting the prognosis of acute-on-chronic liver tailure. Ann Hepatol,2019,18(1):155-164.
[10] Grønbaek H, Møller HJ, Saliba F, et al. Improved prediction of mortality by combinations of inflammatory markers and standard clinical scores in patients with acute-on-chronic liver failure and acute decompensation. J Gastroenterol Hepatol,2021,36(1):240-248.
[11] Solé C, Guilly S, Da Silva K, et al. Alterations in gut microbiome in cirrhosis as assessed by quantitative metagenomics: relationship with acute-on-chronic liver failure and prognosis. Gastroenterology,2021,160(1):206-218.
[12] Zhang Y, Zhao R, Shi D, et al. Characterization of the circulating microbiome in acute-on-chronic liver failure associated with hepatitis B. Liver Int,2019,39(7):1207-1216.
[13] Ponziani FR, Zocco MA, Cerrito L, et al. Bacterial translocation in patients with liver cirrhosis: physiology, clinical consequences, and practical implications. Expert Rev Gastroenterol Hepatol,2018,12(7):641-656.
[14] Mathurin S, Chapelet A, Spanevello V, et al. Infections in hospitalized patients with cirrhosis. Medicina (B Aires),2009,69(2):229-238.
[15] Li C, Wang W, Xie SS, et al. The programmed cell death of macrophages, endothelial cells, and tubular epithelial cells in sepsis-AKI. Front Med,2021,8:796724.
[16] Krones E, Eller K, Pollheimer MJ, et al. NorUrsodeoxycholic acid ameliorates cholemic nephropathy in bile duct ligated mice. J Hepatol,2017,67(1):110-119.
[17] Choy KW, Wijeratne N, Chiang C, et al. Copeptin as a surrogate marker for arginine vasopressin: analytical insights, current utility, and emerging applications. Crit Rev Clin Lab Sci,2024,31:1-21.
[18] Kerbert AJC, Verspaget HW, Navarro ÀA, et al. Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival. Crit Care,2017,21(1):321.
[19] Piano S, Favaretto E, Tonon M, et al. Including relative adrenal insufficiency in definition and classification of acute-on-chronic liver failure. Clin Gastroenterol Hepatol,2020,18(5):1188-1196,e3.
[20] Davenport A, Sheikh MF, Lamb E, et al. Acute kidney injury in acute-on-chronic liver failure: where does hepatorenal syndrome fit? Kidney Int,2017,92(5):1058-1070.
[21] Markwardt D, Holdt L, Steib C, et al. Plasma cystatin C is a predictor of renal dysfunction, acute‐on‐chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis. Hepatology,2017,66(4):1232-1241.
[22] Gomez-casado C, Roth-walter F, Jensen-jarolim E, et al. Modeling iron-catecholates binding to NGAL protein. J Mol Graph Model,2013,45:111-121.
[23] Gambino C, Piano S, Stenico M, et al. Diagnostic and prognostic performance of urinary neutrophil gelatinase‐associated lipocalin in patients with cirrhosis and acute kidney injury. Hepatology,2023,77(5):1630-1638.
[24] Sabbisetti VS, Waikar SS, Antoine DJ, et al. Blood kidney injury molecule-1 is a biomarker of acute and chronic kidney injury and predicts progression to ESRD in type I diabetes. J Am Soc Nephrol,2014,25(10):2177-2186.
[25] Vaidya VS, Ramire V, Ichimura T, et al. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury. Am J Physiol Renal Physiol,2006,290(2):F517-F529.
[26] Acharya P, Saha R, Quadri JA, et al. Quantitative plasma proteomics identifies metallothioneins as a marker of acute-on-chronic liver failure associated acute kidney injury. Front Immunol,2023,13:1041230.
[27] Liu Y, Yuan W, Fang M, et al. Determination of HMGB1 in hepatitis B virus-related acute-on-chronic liver failure patients with acute kidney injury: Early prediction and prognostic implications. Front Pharmacol,2023,13:1031790.
[28] Susantitaphong P, Siribamrungwong M, Doi K, et al. Performance of urinary liver-type fatty acid-binding protein in acute kidney injury: a meta-analysis. Am J Kidney Dis,2013,61(3):430-439.
[29] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版). 中华肝脏病杂志,2019,27(1):9.
[30] Allegretti AS, Solà E, Ginès P, et al. Clinical application of kidney biomarkers in cirrhosis. Am J Kidney Dis,2020,76(5):710-719.
[31] Best LM, Freeman SC, Sutton AJ, et al. Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev,2019,9(9):CD013103.
[32] Arora V, Maiwall R, Rajan V, et al. Terlipressin is superior to noradrenaline in the management of acute kidney injury in acute on chronic liver failure. Hepatology,2020,71(2):600-610.
[33] Angeli P, BernardI M, Villanueva C, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol,2018,69(2):406-460.
[34] Sridharan K, Sivaramakrishnan G. Vasoactive agents for hepatorenal syndrome: a mixed treatment comparison network meta-analysis and trial sequential analysis of randomized clinical trials. J Gen Intern Med,2018,33:97-102.
[35] Nazar A, Pereira GH, Guevara M, et al Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology,2010,51:219-226.
[36] Ding C, Wu X, Fan X, et al. Hemodynamic effects of continuous versus bolus infusion of terlipressin for portal hypertension: a randomized comparison. Gastroenterol. Hepatol,2013,28:1242-1246.
[37] Cavallin M, Piano S, Romano A,et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: a randomized controlled study. Hepatology,2016,63:983-992.
[38] Jindal A, Singh H, Kumar G, et al. Early versus standard initiation of terlipressin for acute kidney injury in ACLF: a randomized controlled trial (eTerli Study).Dig Dis Sci,2024,69(6):2204-2214.
[39] Weinberg JM. Lipotoxicity. Kidney Int,2006,70(9):1560-1566.
[40] Caraceni P, Riggio O, Angeli P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet,2018,391(10138):2417-2429.
[41] China L, Freemantle N, Forrest E, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med,2021,384(9):808-817.
[42] Sourianarayanane A, Raina R, Garg G, et al. Management and outcome in hepatorenal syndrome:need for renal replacement therapy in non-transplanted patients.Int Urol Nephrol,2014,46(4):793-800.
[43] Zhang Z, Maddukuri G, Jaipaul N, et al. Role of renal replacement therapy in patients with type 1 hepatorenal syndrome receiving combination treatment of vasoconstrictor plus albumin. J Crit Care,2015,30(5):969-974.
[44] Karvellas CJ, Taylor S, Bigam D, et al. Intraoperative continuous renal replacement therapy during liver transplantation: a pilot randomized-controlled trial (INCEPTION). Can J Anaesth,2019,66(10):1151-1161.
[45] Niewinski G, Raszeja-wyszomirska J, Hrenczuk M, et al. Intermittent high-flux albumin dialysis with continuous venovenous hemodialysis for acute-on-chronic liver failure and acute kidney injury. Artif Organs,2020,44(1):91-99.
[46] Weinberg EM, Wong F, Vargas HE, et al. Decreased need for RRT in liver transplant recipients after pretransplant treatment of hepatorenal syndrome-type 1 with terlipressin. Liver Transpl,2023,10:1097.
[47] Macdonald AJ, Nadim MK, Durand F, et al. Acute kidney injury in cirrhosis: implications for liver transplantation. Curr Opin Crit Care,2019,25(2):171-178.
[48] Yang H, Sun L, Pang Y, et al. Three-dimensional bioprinted hepatorganoids prolong survival of mice with liver failure. Gut,2021,70(3):567-574.
[49] Pita A, Kaur N, Emamaullee J, et al. Outcomes of liver transplantation in patients on renal replacement therapy: considerations for simultaneous liver kidney transplantation versus safety net. Transplant Direct,2019,5(10):e490.
[50] Bera C, Wong F. Management of hepatorenal syndrome in liver cirrhosis: a recent update. Therap Adv Gastroenterol,2022,15: 17562848221102679.

Early diagnosis and treatment of patients with acute-on-chronic liver failure complicated with acute kidney injury

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[7]	Xu Manman, Yang Yanrong, Li Shanshan, et al. Trends in outcomes of patients with liver failure in our hospital over the past ten years [J]. Journal of Practical Hepatology, 2024, 27(6): 874-877.
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[11]	Huang Jing, Wang Jing, Fang Liang, et al. Predictive efficacy of serum wnt5a and LC3-II levels and MELD score for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure [J]. Journal of Practical Hepatology, 2024, 27(4): 551-554.
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