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Abstract(s)
Introdução: O Síndrome Hepatorrenal é uma consequência possível de doenças hepáticas graves sendo bastante temido pelo seu prognóstico muito reservado. Se não for tratado, evolui invariavelmente para a morte pelo que uma abordagem correcta, rápida e eficaz é essencial para tentar reverter a situação e salvar a vida do doente.
Objectivos: O presente trabalho tem como objectivos compreender a fisiopatologia do Síndrome Hepatorrenal, nomeadamente os mecanismos pelos quais há um atingimento renal grave sem lesão histológica nesse órgão; aferir quais as medidas terapêuticas disponíveis para o Síndrome Hepatorrenal e elaborar uma revisão sobre novas terapêuticas em estudo que possam vir a fazer parte da estratégia de abordagem do Síndrome Hepatorrenal.
Métodos: A bibliografia utilizada nesta dissertação centrou-se, sobretudo, em plataformas on-line, com principal destaque para a Pubmed. Ocasionalmente, também se recorreu ao Medscape, ao B-on e ao UpToDate.
Resultados: Existem ainda vários aspectos por esclarecer acerca da fisiopatologia do Síndrome Hepatorrenal o que limita também a efectividade terapêutica actual. A única hipótese de cura continua a ser o transplante hepático, com ou sem transplante renal concomitante, e as restantes estratégias apenas garantem um aumento modesto da sobrevida para que o doente possa vir a receber esses órgãos em tempo útil. Os métodos recentes como o Sistema de Recirculação Adsorvente Molecular e o Sistema de Separação Fraccionada do Plasma ainda não estão suficientemente estudados para se poder concluir acerca da sua utilidade, embora nenhum deles pareça trazer grandes vantagens relativamente às abordagens tradicionais.
Conclusões: A investigação em torno do Síndrome Hepatorrenal é ainda insuficiente no esclarecimento da patofisiologia da doença. As hipóteses terapêuticas necessitam de maior esclarecimento no que concerne ao perfil do doente ideal para cada uma.
Introduction: Hepatorenal syndrome is a possible result of serious liver diseases and its feared due to its very poor prognosis. If left untreated, invariably progresses to death. Thus, a proper, quick and effective approach is essential to reverse the situation and save the patient's life. Objectives: This study aims to understand the pathophysiology of Hepatorenal syndrome, including the mechanisms by which there is a severe renal involvement without histological lesions in this organ; assess what are the therapeutic measures available for Hepatorenal syndrome and elaborate a review of new therapies under study that may be part of the Hepatorenal syndrome approach in the future. Methods: The literature used in this work focused mainly on online platforms, with main emphasis on Pubmed. Occasionally, Medscape, B-on and UpToDate were consulted. Results: There are still many aspects to be clarified about the pathophysiology of Hepatorenal syndrome which also limits the current therapy effectiveness. Liver transplantation remains the only chance of cure, with or without concomitant renal transplant. The remaining strategies only guarantee a modest increase in survival so that the patient can receive these organs in time. The Molecular Adsorbent Recirculating System and the Fractionated Plasma Separation and Adsorption System are newer methods but have not been sufficiently well studied for the scientific community to conclude definitely about their usefulness. However, none of them seems to bring great advantages compared with traditional approaches. Conclusions: Research around the Hepatorenal syndrome is still insufficient to fully clarify the pathophysiology of the disease. The different therapies require further enlightenment regarding the patient's ideal profile for each one of them.
Introduction: Hepatorenal syndrome is a possible result of serious liver diseases and its feared due to its very poor prognosis. If left untreated, invariably progresses to death. Thus, a proper, quick and effective approach is essential to reverse the situation and save the patient's life. Objectives: This study aims to understand the pathophysiology of Hepatorenal syndrome, including the mechanisms by which there is a severe renal involvement without histological lesions in this organ; assess what are the therapeutic measures available for Hepatorenal syndrome and elaborate a review of new therapies under study that may be part of the Hepatorenal syndrome approach in the future. Methods: The literature used in this work focused mainly on online platforms, with main emphasis on Pubmed. Occasionally, Medscape, B-on and UpToDate were consulted. Results: There are still many aspects to be clarified about the pathophysiology of Hepatorenal syndrome which also limits the current therapy effectiveness. Liver transplantation remains the only chance of cure, with or without concomitant renal transplant. The remaining strategies only guarantee a modest increase in survival so that the patient can receive these organs in time. The Molecular Adsorbent Recirculating System and the Fractionated Plasma Separation and Adsorption System are newer methods but have not been sufficiently well studied for the scientific community to conclude definitely about their usefulness. However, none of them seems to bring great advantages compared with traditional approaches. Conclusions: Research around the Hepatorenal syndrome is still insufficient to fully clarify the pathophysiology of the disease. The different therapies require further enlightenment regarding the patient's ideal profile for each one of them.
Description
Keywords
Diálise Síndrome Hepatorrenal Terlipressina Transplante Tratamento