علاج الفشل الكبدي المزمن في تليف الكبد مع متلازمة الكبد الكلوي — الإصابة الحادة في الكلى (HRS-AKI)

References

DOI: 10.1016/j.jhep.2018.03.024

Vasoconstrictors and albumin are recommended in all patients meeting the current definition of AKI-HRS stage >1A, should be expeditiously treated with vasoconstrictors and albumin (III;1).

Terlipressin plus albumin should be considered as the first-line therapeutic option for the treatment of HRS-AKI. In case of non-response (decrease in SCr <25% from the peak value), after two days, the dose of terlipressin should be increased in a stepwise manner to a maximum of 12 mg/day (I;1).

Noradrenaline can be an alternative to terlipressin. However, limited information is available (I;2).

Midodrine plus octreotide can be an option only when terlipressin or noradrenaline are unavailable, but its efficacy is much lower than that of terlipressin (I;1).

According to the new definition of HRS-AKI, complete response to the treatment should be defined by a final SCr within 0.3 mg/dl (26.5 μmol/L) from the baseline value, while partial response should be defined by the regression of AKI stage to a final SCr ≥0.3 mg/dl (26.5 μmol/L) from the baseline value (III;1).

Treatment should be maintained until a complete response (SCr below 1.5 mg/dl) or for a maximum of 14 days either in case of partial response (decrease of SCr ≥50% with a final value still higher than 1.5 mg/dl) or in case of non-response.

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