Varela-Jiménez RE , Jiménez-Vega AR , Carrillo-Pérez DL , Carrillo-Maravilla E , Rodríguez-Ramírez S

Idioma: Español
Referencias bibliográficas: 46
Paginas: 134-140
Archivo PDF: 175.11 Kb.

RESUMEN

El síndrome hepatorenal es una forma de lesión renal aguda pre-renal que no responde a expansión de volumen. Ocurre en pacientes con cirrosis hepática avanzada o insuficiencia hepática aguda y a pesar de tener una baja incidencia, confiere una alta mortalidad. Es un diagnóstico de exclusión, que comparte características clínicas con otras causas de lesión renal aguda en el paciente con cirrosis hepática, lo que hace particularmente difícil su diagnóstico y tratamiento temprano. La peritonitis bacteriana espontánea es el principal factor desencadenante y debe ser descartada en todo paciente con cirrosis y deterioro de la función renal. La prevención es la mejor forma de tratamiento. Debe utilizarse profilaxis antibiótica primaria en pacientes con riesgo de peritonitis, así como el empleo de albúmina en paracentesis de gran volumen y uso racional de diuréticos y nefrotóxicos. Los fármacos betabloqueadores deben suspenderse posterior al primer episodio de peritonitis bacteriana espontánea. El trasplante hepático ortotópico es el tratamiento de elección y debe considerarse en todo paciente con síndrome hepatorenal. En pacientes no candidatos a trasplante hepático, la terapia de reemplazo renal no mejora el pronóstico. El trasplante simultáneo de hígado-riñón está indicado en pacientes con terapia dialítica pre-trasplante mayor a 8 semanas.

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