Sound waves and solutions:Point-of-care ultrasonography for acute kidney injury in cirrhosis  

作　　者：David Aguirre-Villarreal Mario Andrés de Jesús Leal-Villarreal Ignacio García-Juárez Eduardo R Argaiz Abhilash Koratala 

机构地区：[1]Departamento de Gastroenterología,Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,Mexico City 14080,Mexico [2]Cardiología,Instituto Nacional de Cardiología Ignacio Chávez,Mexico City 14080,Mexico [3]Unidad de Hepatología y Trasplante,Departamento de Gastroenterología,Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran,Mexico City 14080,Mexico [4]Departamento de Nefrología y Metabolismo Mineral,Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,Mexico City 14080,Mexico [5]Tecnológico de Monterrey,Escuela de Medicina y Ciencias de la Salud,Mexico City 64710,Mexico [6]Department of Nephrology,Medical College of Wisconsin,Milwaukee,WI 53226,United States

出　　处：《World Journal of Critical Care Medicine》2024年第2期83-92,共10页世界重症医学杂志

基　　金：Supported by Research funding from KidneyCure and the American Society of Nephrology’s William and Sandra Bennett Clinical Scholars Grant(to Abhilash Koratala).

摘　　要：This article delves into the intricate challenges of acute kidney injury(AKI)in cirrhosis,a condition fraught with high morbidity and mortality.The complexities arise from distinguishing between various causes of AKI,particularly hemodynamic AKI,in cirrhotic patients,who experience hemodynamic changes due to portal hypertension.The term"hepatocardiorenal syndrome"is introduced to encapsulate the intricate interplay among the liver,heart,and kidneys.The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis,unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function.The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed,highlighting potential risks and variable patient responses.We advocate for a nuanced algorithm for AKI evaluation in cirrhosis,prominently featuring point-of-care ultrasonography(POCUS).POCUS applications encompass assessing fluid tolerance,detecting venous congestion,and evaluating cardiac function.

关 键 词：Point-of-care ultrasonography Bedside ultrasound CIRRHOSIS CONGESTION Acute kidney injury Congestive nephropathy 

分 类 号：R692[医药卫生—泌尿科学]