GEPATORENALNY SYNDROME (grech, hepar, hepat [os] liver + lat. ren kidney; syndrome; synonym hepatonephric syndrome) — set of the symptoms developing at simultaneous acute damage of a liver and kidneys. This designation is used more and more seldom, giving way to the term «acute hepatonephric insufficiency» or the specific name of various forms of damages of a liver and kidneys.
- the river of page is not a nosological form and develops at many patol, states, especially at simultaneous impact on a liver and kidneys gepato-and nefrotoksichny factors. The most frequent reason of G. - rubles of page are: infectious influences, napr, hemorrhagic fever with a renal syndrome, sepsis; chemical intoxications, napr, ethylene glycol (antifreeze), dichloroethane, nek-ry hepatotropic medicines (antiepileptic, narcotic) and other substances; hemolysis at hemotransfusion; surgical interventions, napr, on a stomach, at cholecystitis and other diseases; acute pancreatitis; administration of radiopaque substances etc.
As a rule, the first struck body is the liver, but G. - river of page can arise and as simultaneous defeat of both bodies (at infections, acute poisonings etc.). Less often initially kidneys, napr are surprised, at an anthrax of kidneys, purulent pyelonephritis.
In G.'s development - the river of page plays a role and functional interrelation of a liver and kidneys. At primary damage of a liver (with considerable disturbance of bilirubinovydelitelny, fermentoobrazovatelny and anti-toxic functions) toxicants are neutralized not completely, functions of endocrine and nervous systems, including their coordinating influence on activity of «internal and external filters of an organism» — a liver and kidneys are broken. Thereof, and also the direct damaging effect of toxins in patol, process kidneys are involved, and an essential role is played by acute disorders of blood circulation and necrotic processes in nephrons.
the Liver flabby, icteric, its weight is increased or, on the contrary, is reduced (acute dystrophy); at microscopic examination in a liver note dystrophy of hepatocytes, necroses, the phenomena of a cholestasia. Kidneys are increased, bulked up, borders cortical and a medulla are indistinct, bark can be pale; at microscopic examination find acute changes of blood circulation with ischemia and necroses of cortical substance, acute dystrophic and necrotic changes of an epithelium of renal tubules, swelled an interstitium.
The current and symptoms
Are noted signs of the acute hepatonephric insufficiency making G.'s being - river of page: jaundice, the phenomena of a cholemia, increase (with the subsequent reduction) the sizes of a liver, morbidity in right hypochondrium, and also an oliguria or even an anury, a delay of nitrogenous slags in blood (urea, creatinine, etc.), a proteinuria, in an urocheras abundance of cells and cylinders.
On degree of manifestation distinguish G. - river of page of easy, average and heavy degree. At exogenous G. - rubles of page (owing to acute poisoning) allocate the following phases of a current: all-toxic, hepato-renal, oligo-anuretic, poliurichesky, recovery.
Treatment is directed first of all to a basic disease, and for the rest comes down to urgent actions against an acute liver and renal failure. A carbohydrate diet with sharp restriction of protein and fat, gepatozashchitny drugs are shown (glutaminic to - that, B6 and B15 vitamins, to lay down. amino acids, cocarboxylase, lipotropic substances; in less acute phase — Sireparum and other hepatic extracts), an oxygenotherapy; in a phase of preferential damage of a liver — Prednisolonum (40 — 100 mg a day; for children at the rate of 1 — 2 mg on 1 kg of weight). Intravenous injections of 5% of solution of glucose (0,5 — 1,5 l), small doses of insulin (6 — 12 PIECES), drugs of calcium, osmotic diuretic are appointed; according to indications — peritoneal dialysis, a hemodialysis (an artificial kidney). Apply a method of a heteroliver, i.e. dialysis of blood of the patient through the worrying liver of an animal (e.g., pigs) to fight against a hepatic coma and intoxication. In the presence of infectious process use low-toxic antibiotics (penicillin, Oxacillinum, etc.). In case of blood loss drop injections of fresh blood are shown. At G. - the ruble of page who developed as a complication of a hemotransfusion do exchange hemotransfusion, a hemodialysis.
Forecast it is always serious.
Prevention is the prevention and timely treatment of diseases at which G. - the river of page can arise (acute hepatotropic and renotrophic intoxications, transfusion complications, hepatotoxic types of an anesthesia), the correct maintaining patients in the postoperative period, timely use of complex therapy at exogenous and endogenous intoxications.
The hepato-renal syndrome at children
the Hepato-renal syndrome at children develops for the same reasons, as at adults, but is especially frequent at diseases of a liver with the instruction in the anamnesis on a nephropathy, and also at diseases of kidneys with various metabolic disturbances. Distinguish infectious, toxic, postoperative and cryptogenic forms G. - river of page.
A specific place is held by G. - river of page with simultaneous damage of a liver and kidneys at hereditarily the caused disbolism which are followed by the increased concentration in biol, liquids of cystine, oxalates, uric to - you.
At G.'s development - river of page against the background of intoxication its symptoms become more expressed: nausea, vomiting, locks, weight reduction of a body, hemorrhage; tachycardia, muting of cardiac sounds, lowering of arterial pressure are noted. In hard cases symptoms of defeat of c are observed. N of page: drowsiness, apathy, polyneurites and Meningeal symptoms. At a blood analysis find the expressed leukocytosis, acceleration ROE, and also a hypoalbuminemia, a hyper aminoacidemia. In urine come to light protein, erythrocytes, cylinders, sometimes leukocytes and amino acids. During development of an azotemia the content in blood of protein, fibrinogen, sodium decreases.
Treatment and prevention — as at adults.
Bibliography: Ignatova M. S. and Yu. E Veltishchev. Diseases of kidneys at children, page 236, M., 1973; Lebedeva R. N., Tretyakov E.G. and And yes to mind about in V. V. Postoperative hepatonephric syndrome, Surgery, No. I, page 81, 1974; Nikiforov V. N. and La cynic G. E. Proyavleniya gepato-renal-nogo a syndrome at a viral hepatitis, Owls. medical, No. 11, page 89, 1974, bibliogr.; Topchiashvili 3. And. isergiyen-to about V. S. Gemodializ at hepatonephric insufficiency, Surgery, No. 10, page 14, 1971; Chukhriyenko D. P. of ides of river. A hepato-renal syndrome at acute pancreatitis, in the same place, No. 7, page 35, 1972; Fisher J. and. J a m e s J. H. Treatment of hepatic coma and hepatorenal syndrome, Amer. J. Surg., v. 123, p. 222, 1972; Gross-m a n n P. Padiatrische Nephrologie, Lpz., 1970, Bibliogr.
G. P. Shultsev; E. I. Barinovskaya, V. P. Lebedev (ped.).