Hepatorenal Sendrom ve Tıbbi Beslenme Tedavi Yaklaşımı

Hepatorenal sendrom (HRS), özellikle ileri derece sirozlu ve ascitli hastalarda oluşan, belirgin dolaşım bozukluğu ile karakterize, son dönem karaciğer hastalığının ciddi bir komplikasyonudur. HRSde, böbrek ve dolaşım işlevlerindeki bozukluk birlikte görülmektedir. İç organlara ait dilatasyona cevap olarak ciddi renal vazokonstriksiyona bağlı hepatorenal sendrom görülmektedir. İki tip HRS vardır. Tip 1 HRSde hastalığın prognozu çok ciddidir. Renal ve dolaşım işlevlerinde çok hızlı bir bozulma vardır. Hastaların ortalama yaşam süresi 2 haftadan azdır. Tip 2 HRSde ise böbrek işlevlerinde bozulma daha yavaş ancak süreklidir. Karaciğer ve beraberindeki renal işlev bozukluğunun da ortadan kaldırılması açısından en etkili ve ideal tedavi yöntemi karaciğer transplantasyonudur ve tüm bu süreçlerde tıbbi beslenme tedavisi büyük önem taşır.

Hepatorenal Syndrome and Medical Nutrition Therapy Approaches

Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease which occurs especially in patients with advanced cirrhosis and ascits and characterized by specific circulatory disorder. Impaired renal functions and circulatory disorders go about in HRS. HRS is formed due to severe renal vasoconstriction in response to dilatation of the internal organs. There are two types of HRS. Type 1 HRS is characterized by a rapidly progressive impairment of the circulatory and renal functions associated with a very poor prognosis and the median survival rate lower than 2 weeks. Type 2 HRS is characterized by a steady but constant impairment of the circulatory and renal functions. The ideal method for liver transplantation to treat hepatic dysfunction is accompanied by renal dysfunction and medical nutrition therapy has place great importance in all of these processes. Keywords: Acute renal failure, end stage liver disease, hepatorenal syndrome

PDF

___

1.Angeli P, Merkel C. Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis. J Hepatol 2008;48:93-103. 2.Salerno F, Gerbes A, Gines P, Wong, F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007;56:1310-1318. 3.Perz JF, Armstrong GL, Farrington LA, Hutin YJF, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-538. 4.Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 2003;37:1202-1219. 5.Paschos P, Paletas K. Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia 2009;13:9-19. 6.Gines P, Martin PY, Niederberger M. Prognostic signicance of renal dysfunction in cirrhosis. Kidney Int Suppl 1997;51:77-82. 7.Fasolato S, Angeli P, Dallagnese L, Maresio G, Zola E, Mazza E. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology 2007;45:223-229. 8. Eckardt U. Renal failure in liver disease. Intensive Care Med 1999;25:5-14. 9. Gines P, Guevara M, Arroyo V. Hepatorenal syndrome. Lancet 2003 ;362:1819-1827. 10. Thuluvath PJ. Hepatorenal syndrome. World J Gastroenterol 2007;13:4046-4055. 11. Kum I, Cheng P. Hepatorenal syndrome. Hong Kong J Nephro 2002;4:78-86. 12. Betrosian AP, Agarwal B, Douzinas EE. Acute renal dysfunction in liver diseases. World J Gastroenterol 2007;13:5552-5559. 13. Arroyo V, Guevara M, Gines P. Hepatorenal syndrome in cirrhosis: Pathogenesis and treatment. J Gastroenterol 2002;122:1658-1676. 14. Bataller R, Sort P, Gines P, Arroyo V. Hepatorenal syndrome: Definition, pathophysiology, clinical features and management. Kidney Int 1998;53:47-53. 15. Arroyo V, Gines P, Jimenez V, Rodes J. Renal dysfunction in cirrhosis. In: Bircher J, Benhamou J-P, McIntyre N, et al, eds. Oxford Textbook of Clinical Hepatology. Oxford: Oxford University Press 1999. p. 733-761. 16. Epstein M. Hepatorenal syndrome: emerging perspectives of pathophysiology and therapy. J Am Soc Nephrol 1994;4:1735-1753. 17. Ortega R, Gines P, Uriz J, Cardenas A, Calahorra B, De Las Heras D, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of prospective, nonrandomized study. Hepatology 2002;36:941-948. 18. Gines A, Escorsell A, Gines P, Salo J, Jimenez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. J Gastroenterol 1993;105:229-236. 19. Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23:164- 176. 20. Gines P. Diagnosis and treatment of hepatorenal syndrome. Baillieres Clinical Gastroenterology 2000;14: 945-957. 21. Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy clinical features, and outcome in a tertiary care centre. Am J Gastroenterol 2002;97:2046- 2050. 22. Guevara M, Rodes J. Hepatorenal syndrome. In: Friedman LS, Keeffe EB, editors. Handbook of Liver Disease. 3rd ed. Elseiver Saunders; 2012. p. 282-295. 23. Wong F, Blendis L. Renal sodium retention in portal hypertension and hepatorenal reflex: from practice toscience. Hepatology 2003;37:1494-1495. 24. Cardenas A. Hepatorenal Syndrome: A dreaded complication of end stage liver disease. Am J Gastroenterol 2005;100:460-467. 25. Akil İ, Kasırga E. Hepatorenal Sendrom. Erciyes Tıp Dergisi 2004;26:132-140. 26. Cardenas A, Gines P. Hepatorenal Syndrome. Clinical Liver Disease 2006;3:371-385. 27. Zeyneloğlu P. Hepatorenal Sendrom. Türk Yoğun Bakım Dergisi 2012;10:37-44. 28. Choi CP, Kim HJ, Choi WH, Park DI, Park JH, Cho YK, et al.Model for end-stage liver disease model for end-stage liver disease-sodium and Child Turcotte Pugh scores over time for the prediction of complications of liver cirrhosis. Liver Int 2009;6:221-226. 29. Dutkowski P, Oberkofler CE, Be ́Choir M, Mllhaupt B, Geier A, Raptis DA, et al.The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis. Liver Transpl 2011;17:674-684. 30. Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller M. ESPEN Guidelines for nutrition in liver disease and transplantation. Clin Nutr 1997;16:43-55. 31. Pekcan G. Beslenme Durumunun Saptanması. Baysal A, Aksoy M, Besler HT, Bozkurt N, Keçecioğlu S, Mercanlıgil MS, Merdol Kutluay T, Pekcan G, Yıldız E. Diyet El Kitabı. Yenilenmiş 6. Baskı. Ankara: Hatiboğlu Basım ve Yayım San. Tic. Ltd. Şti; 2011. p. 67-142. 32. ESPEN Guidelines 2006. Aliment Pharmacol Ther 2006;24:563-572. 33. Gunsar F, Raimondo ML, Jones S, Terreni N, Wong C, Patch D, et al. Nutritional status and prognosis in cirrhotic patients. Aliment Pharmacol Ther 2006;24:563-572. 34. Kahraman A, Hilsenbeck J, NygaM, ErtleJ, WreeA, PlauthM,et al. Bioelectrical impedance analysis in clinical practice: implications for hepatitis C therapy BIA and hepatitis C. Virol J 2012;7:191. 35. Campillo B, Richardet JP, Bories PN. Enteral nutrition in severely malnourished and anorectic cirrhotic patients in clinical practice. Gastroenterol Clin Biol 2005;29:645-651. 36. Cheung K, Samuel S, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 2012;10:117-125. 37. Tomas MT, Santa-Clara MH, Monteiro E, Baynard T, Carnero EA, Bruno PM, et al. Body composition, muscle strength, functional capacity, and physical disability risk in liver transplanted familial amyloidotic polyneuropathy patients. Clin Transplant 2011;25:406- 414. 38. Zelber-Sagi S, Nitzankaluski D, Halpern Z, Oren R. Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures. Liver Int 2006;26:856-863. 39. Hasse JM, Matarese LE. Medical Nutrition Therapy for Liver, Biliary System, and Exocrine Pancreas Disorders. In: Mahan KL, Escott-Stump S, editors. Krauses Food&Nutrition Therapy. Edition 12. Canada: Saunders Elseiver; 2008. p. 707-732. 40. Mercanlıgil MS.Karaciğer, Safra Kesesi ve Pankreas Hastalıklarında Besleme. Baysal A, Aksoy M, Besler HT, Bozkurt N, Keçecioğlu S, Mercanlıgil MS, Merdol Kutluay T, Pekcan G, Yıldız E. Diyet El Kitabı. Yenilenmiş 6. Baskı. Ankara: Hatiboğlu Basım ve Yayım San. Tic. Ltd. Şti; 2011. p. 179-214. 41. B ́Emeur C, Desjardins P, Butterworth RF. Role of nutrition in the management of hepatic encephalopathy in end-stage liver failure. Journal of Nutrition and Metabolism 2012 [E-pub ahead of print], doi :10.1155/2010/489823. 42. Valentini L, Schutz T, Allison S, Howard P, Pichard C, Lochs H. ESPEN Enteral Nütrisyon Rehberi. Ankara: Miki Matbaacılık; 2012. p.94-101. 43. Yandakçı K. Beslenmede Özel Ürünler Gerekli Mi? Klinik Beslenme Desteği ve Güncel Yaklaşımlar Sempozyumu. 19-20 Mart 2010. Bildiri ve Konuşma Özetleri Kitabı. 44. Valentini L, Schutz T, Allison S, Howard P, Pichard C, Lochs H. Türkçe Çeviri; Kutlay O, Gündoğdu H. ESPEN Parenteral Nütrisyon Rehberi. Ankara: Miki Matbaacılık;2012. p.94-102. 45. Masuda T, Shirabe K, Yoshiya S, Matono R, Morita K, Hashimoto N, et al. Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease. JPEN 2012 [E-pub ahead of print], doi: 10.1177/0148607112456041. 46. Cabré E, Gassull MA. Nutritional aspects of liver disease and transplantation. Curr Opin Clin Nutr Metab Care 2011;4:581-589.