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Síndrome hepatorrenal - Treatment

Tratamiento:

El tratamiento está encaminado a mejorar la función del hígado y garantizar que haya suficiente volumen de sangre en el cuerpo y que el corazón esté bombeándola de manera adecuada.

Esta enfermedad generalmente se trata de la misma manera como se trata una insuficiencia renal por cualquier otra causa.

  • Se deben suspender todos los medicamentos innecesarios, especialmente el antibiótico neomicina, el ibuprofeno y otros AINES, al igual que los diuréticos.
  • La diálisis puede mejorar los síntomas.
  • Medicamentos como octreotida más midodrina, albúmina o dopamina pueden emplearse temporalmente para mejorar la función renal.
  • Se utiliza una derivación no quirúrgica (conocida como TIPS, por sus siglas en inglés) para aliviar los síntomas de ascitis y para ayudar a la función renal. La cirugía para colocar una derivación (llamada derivación de Levine) desde el espacio abdominal (peritoneo) hasta la vena yugular también puede aliviar algunos de los síntomas de insuficiencia renal. Ambos procedimientos son riesgosos y es muy importante la selección apropiada de los pacientes.

Expectativas (pronóstico):

El resultado predecible es desalentador y la muerte generalmente ocurre como resultado de infecciones secundarias o hemorragia.

Complicaciones:

Situaciones que requieren asistencia médica:

Esta enfermedad se diagnostica generalmente en el hospital, durante el tratamiento de un trastorno hepático.

  • Reviewed last on: 5/4/2010
  • David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Referencias

Garcia-Tsao G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 157.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.

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