İlerlemiş Karaciğer Rahatsızlığında Böbrek Yetmezliği

Year 1974, Volume: 27 Issue: 1-2, 451 - 467, 30.06.1974

Esat Erenoğlu

https://izlik.org/JA97NB47DF

Abstract

Oligourik renal yetmezlik gerek ileri sirozlu hastalarda ve gerekse diğer karaciğer hastalıklarında sık rastlanan bir ölüm sebebidir. Sendrom Azotemi, oliguri, dilüsyon hiponatremisi düşük sodyum itrahı ve böbrek de hiç karakteristik bir bozukluk olmamasiyle karakterizedir. Klklinik tablo genellikle Hepato - Renal sendrom olarak adlandır( l Bu terimin kullanılması eleştirilebilir. çünkü işin, karaciğer ve böbrek. arasında direkt bir ilginin bulunduğu anlamına gelir ki, böyle bir ilgi gösterilmemiştir. Yine bu terim karaciğer ve böbreğin beraberce musab olduğu diğer birçok tablolardan ayrılmasında da bir yayılımı olmaz. Böbrek dolaşım yetmezliği veya fonksiyonel böbrek yetmezlik terimleri teklif edildi. Fakat bu 'yine de memnun edici değildiler. Böbrek su ve tuz metabolizma boz,uklukları, ilerlemis karaciğer hastalığına tamamen refakat edebilir ve böbrek dolaşım bozukluğu olmadan da olabilir. Burada renal hemodinamideki bozukluktan ve su ve tuzu ayarlamasından bahsedildi.

Keywords

karaciğer hastalıkları , böbrek yetmezliği , iç hastalıkları

Supporting Institution

Ankara University Faculty of Medicine

Kidney Failure in Advanced Liver Disease

https://izlik.org/JA97NB47DF

Abstract

Oligurik renal failure is frequently the cause of death in advanced cirrhosis as well as in hepatic failure from other causes. This syndrome is characterized by the spontanceous development of azotemia, oliguria, dilutional hyponatremia, low urinary sodium excretion, and the absence of significant histologic abnormalities of the kidney. The condition is often refered to as the «hepatorenal syndrome»a term that should be abandoned because it implies'a cirect interrelationship between the liver and kidney that has not been demonstrated. Also, it does not differentiate the condition under consideration from several others in which both the kidney and liver are involved. The terms renal circulatory failure and functional renal failure have been suggested and, although not entirely satisfactory, are preferable. Abnormalities of renal. salt and water metabolism commonly accompany advanced liver disease and may occur independently of renal circulatory failure.

Keywords

diseases of liver , kidney failure , internal diseases

Supporting Institution

Ankara University Faculty of Medicine

References

• 1 — Summerskill, W. H. J. : Hepatic failure and the kidney, rology, 51:94 107, 1966.
• 2 — Reynolds, T. B., Lieberman, F. L. , Redeker, A. G. : Functional renal failure with cirrhosis : The effect of plasma expansion therapy, Medicine (Baltimore), 46:191 196, 1967.
• 3 W, P., Feichter, R. N., Summerskill, W. H. Hunt J. C., wa n kim K. G. : The kidney in cirrhosis, 11. Disorders of renal function, Ann Intern Med., 60:366 - 377, 1964.
• 4 Lieberman, F. L. , Reynolds, T. B. : Renal failure with cirrhosis : Observations on the role of diuretics, Ann. Intern. Med., 64: 1221 - 1228, 1966.
• 5 — Shear, L., Kleinerman, J. , Gabuzda, G. J. : Renal failure in patients with cirrhosis of the liver, 1. Clinical and pathologic charateristics, Amer. J. Med., 39:184 - 198, 1965.
• 6 Salomon, M. I. , Sakaguchi, H., Churg, J., Dachs, S., Grishman, E. , Mautner, W., Paronetto, F. , Rosenthal, W. S. : Renal lesions in hepatic disease : A study based on kidney bopsy, Arch. Intern. Med. (Chicago), 116:704 - 709, 1965.
• 7 Koppel, M. H., Coburn, J. W., Mims, M. M., Goldstein, H., Boyle, J. D, Rubini, M. E. : Transplantation of cadaveric kidneys from patients with svndrome : F}vidence for the functional nature of renal failure in advanced liver disease, N. Eng. J. Med., 280:1367 - 1371, 1969.
• 8 — Harvey, R. B. : Effects of acetylcholin infused into renal artery of dogs, Amer. J. Physiol., 211:487 - 492, 1966.
• 9 — Barnardo, D. E., Baldus, W. P. , Maher, F. T. : Affects of dopamine on renal function in patients with cirrhosis, Gastroenterology, 58 :524 - 531, 1970.
• 10 — Laragh, J. H., Ames, R. P. : Physiology of body water and electrolytes in hepatic disease, Med. Clin. N. Amer., 47:587 - 606, 1963.
• 11 — McCloy, R. M., Baldus, W. P., Tauxe, W. N., Summerskill, W. H. t. : Plasma volume and renal circulatory function in cirrhosis, Ann. Intern. Med., 66:307 311, 1967.
• 12 — Shear, Ia., Hall, P. W. 111, Gabuzda, G. J. : Renal failure in patients with cirrhosis of the liver. 11. Factors influencing maximal urinary flow rate, Amer. J. Med., 39: 199 - 209, 1965.
• 13 — Handley, C. A. , Moyer, J. H. : Unilateral renal adrenergic blockade and the renal resoonse to vasopressor agents and to hemorrhage, J. Pharmacol Exp. Ther., 112:1 - 7, 1954.
• 14 Epstein, M., Berk, D. P. , Hollenberg, N. K. , Adams, D. F., Chalmers, T. C. , Abrams, H. L. , Merrill, J. P. : Renal failure in the patient with cirrhosis : The role of active vasoconstriction, Amer. J. Med., 49:175 185, 1970.
• 15 Baez, S. , Mazur; A e; Schorr. E. : Henatorenal factors in circulatory homeostasis. XX. Antidiuretic action of hepatic vasodepressor, VIM (ferritin), Amer. J. Physiol., 162:198 - 212, 1950.
• 16 — Tristani, F. m, Cohn, J. N. : Systemic and renal hemodynamics in oliguric hepatic failure : Effect of volume expansion, J. Clin. Invest., 46: 1894 - 1906, 1967.
• 17 — Lieberman, F. L. , Ito, S., Reynolds, T. B. : Effective plasma volume in cirrhosis with ascites : Evidence that a decreased value does not account for renal sodium. retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR during drug-induced diuresis, J. Clin. Invest., 48:875 - 981, 1969. 18 Hanback, L. D. Jr. : Renal hemodynamics fel lnwing minimal hepatic outflow block, Surg. Forum. , 21:364 - 366, 1970.
• 19 Schroeder, E. T. , Numann, P. J., Chamberlain, B. E. : Functional renal failure in cirrhosis : Recovery after portacaval shunt, Ann. Intern. Med., 72:923 - 928, 1970.
• 20 — Bircher, J., Haemmerli, U. P., Scollo-Lavizzari, G. , Hoffman, K. : Treatment of chronic portal-systemic encephalopathy with lactulose : Report of six patients and review of the literature, Amer. J. Med., 51:148 159, 1971.
• 21 Sugerman, H. J., Berkowitz, H. D, Davidson, D. T., Miller, L. D. : Treatment of the hepatorenal syndrome with metaraminol, Surg. Forum., 21•.359 - 361, 1970.