2010EASL肝肾综合征指南.doc

2010EASL《肝硬化腹水、自发性腹膜炎和肝肾综合征的临床实践指南》——肝肾综合征推荐意见（英文原文） 来源：?作者：国际肝病?发布时间：2010-9-1 14:13:39???阅读：85? 　　It is important to make the diagnosis of HRS or identify other known causes of renal failure in cirrhosis as early as possible. The causes of renal failure in cirrhosis that should be excluded before the diagnosis of HRS is made include: hypovolemia， shock， parenchymal renal diseases， and concomitant use of nephrotoxic drugs. Parenchymal renal diseases should be suspectedif thereis significant ? 推荐意见： 1.It is important to make the diagnosis of HRS or identify other known causes of renal failure in cirrhosis as early as possible. The causes of renal failure in cirrhosis that should be excluded before the diagnosis of HRS is made include: hypovolemia， shock， parenchymal renal diseases， and concomitant use of nephrotoxic drugs. Parenchymal renal diseases should be suspectedif thereis significant proteinuriaormicrohaematuria， or if renal ultrasonography demonstrates abnormalities in kidney size. Renal biopsy is important in these patients to help plan the further management， including the potential need for combined liver and kidney transplantation (Level B1). ? 2.HRS should be diagnosed by demonstrating a significant increase in serum creatinine and excluding other known causes of renal failure. For therapeutic purposes， HRS is usually diagnosed only when serum creatinine increases to 133 lmol/L (1.5mg/dl). Repeated measurement of serum creatinine over time， particularly in hospitalized patients， is helpful in the early identification of HRS (Level B1). ? 3.HRS is classified into two types: type 1 HRS， characterized by a rapid and progressive impairment in renal function (increase in serum creatinine of equal to or greater than 100% compared to baseline to a level higher than 2.5 mg/dl in less than 2 weeks)， and type 2 HRS characterized by a stable or less progressive impairment in renal function (Level A1). ? 4.Patients with type 1 HRS should be monitored carefully. Para