当科における1型肝腎症候群の実態

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  • Incidence, clinical characteristics, treatment and prognosis of type 1 hepatorenal syndrome: A single institution experience

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A total of 929 patients with liver cirrhosis were admitted to our department between 2004 and 2009. Of these, 142 patients were complicated by kidney injury, with creatinine of 1.5 mg/dl or higher at or after admission. One hundred six out of 142 patients developed acute kidney injury, and including 27 with type 1 hepatorenal syndrome.<br>We retrospectively investigated the background, treatment and prognosis of type 1 hepatorenal syndrome in 27 patients. The 27 patients were selected according to the diagnostic criteria for hepatorenal syndrome proposed by International Ascites Club. Average Child-Pugh score was 12.4, total bilirubin 15.1 mg/dl, and creatinine 3.22 mg/dl in the 27 patients. Precipitating factors were infection (n=16), paracentesis (n=5) and other causes (n=6). These 27 patients were treated with albumin (n=21), terlipressin (n=11), dopamine (n=11), noradrenaline (n=1), hemodiafiltration (n=1). Of 16 patients treated with conventional therapies other than terlipressin, 15 died. Their mean survival time was 12 days.<br>Type 1 hepatorenal syndrome occurred in 25% of the cirrhotic patients with acute kidney injury. This syndrome developed as a consequence of severe hepatic failure and the prognosis following conventional therapy was quite poor.

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