La fisiopatología como base del diagnóstico y tratamiento de la lesión renal aguda en cirrosis.
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oct 9, 2026
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https://doi.org/10.36677/medicinainvestigacion.v14i2.24812
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Marbella Haddad Toledo
http://orcid.org/0000-0002-1844-7017
Yukiko Harumi Yamasaki Ramos, Dra.
http://orcid.org/0000-0001-6607-1336
Luis Humberto Torres Pérez, Dr.
http://orcid.org/0000-0003-3256-0478
Arturo Aurelio Ortiz Olivarez, Dr.
http://orcid.org/0009-0005-7593-6035
http://orcid.org/0000-0002-1844-7017
Yukiko Harumi Yamasaki Ramos, Dra.
http://orcid.org/0000-0001-6607-1336
Luis Humberto Torres Pérez, Dr.
http://orcid.org/0000-0003-3256-0478
Arturo Aurelio Ortiz Olivarez, Dr.
http://orcid.org/0009-0005-7593-6035
Resumen
La lesión renal aguda se define como el deterioro repentino de la función renal, caracterizado por un aumento en los niveles de creatinina superior a 1.5 mg/dL. El síndrome hepatorrenal (SHR) es una alteración funcional que se presenta en pacientes con cirrosis, como consecuencia de anormalidades circulatorias provocadas por la sobreactivación de sistemas vasoactivos y mediadores del daño. El propósito de este trabajo es revisar las nuevas propuestas de definición, clasificación, teorías fisiopatológicas como base del diagnóstico y tratamiento del SHR. Se realizó una revisión de 30 fuentes bibliográficas en inglés obtenidas de revistas internacionales. El Consenso Internacional de Ascitis redefine la enfermedad renal en el contexto del SHR en dos categorías: SHR-AKI (agudo) y SHR-NAKI (no agudo). La patogenia continúa en estudio y se relaciona con el desarrollo de hipertensión portal, la cual genera un estado proinflamatorio que contribuye a la disfunción sistémica, siendo los cambios hemodinámicos el principal factor desencadenante.
El tratamiento principal se basa en la administración oportuna de albúmina y vasoconstrictores para prevenir complicaciones irreversibles. Se están investigando nuevas terapias, como el uso de TIPS, así como nuevas perspectivas sobre el trasplante hepático y renal conjunto.
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Article Details
Como citar
HADDAD TOLEDO, Marbella et al.
La fisiopatología como base del diagnóstico y tratamiento de la lesión renal aguda en cirrosis..
Medicina e Investigación Universidad Autónoma del Estado de México, [S.l.], v. 14, n. 2, p. 116-124, oct. 2026.
ISSN 2594-0600.
Disponible en: <https://medicinainvestigacion.uaemex.mx/article/view/24812>. Fecha de acceso: 13 oct. 2026
doi: https://doi.org/10.36677/medicinainvestigacion.v14i2.24812.
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Artículos de revisión
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-SinObrasDerivadas 4.0.
Citas
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García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G. Where does TIPS fit in the management of patients with cirrhosis? JHEP Rep. 2020;2(4):100122. DOI: 10.1016/j.jhepr.2020.100122
Sanyal AJ, Genning C, Reddy KR, et al. The North American study for the treatment of refractory ascites. Gastroenterology 2003;124. DOI: 10.1053/gast.2003.50088
Sellers CM, Nezami N, Schilsky ML, et al. Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: Current state and future directions. Transplant Rev. 2019;33(2):64–71. DOI: 10.1016/j.trre.2018.10.004
Song T, Rössle M, He F, et a. Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis. Dig Liver Dis 2018 50(4):323–30. DOI: 10.1016/j.dld.2018.01.123
Allegretti AS, Parada XV, Eneanya ND, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):16-25. DOI: 10.2215/CJN.03610417.
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Jones BE, Allegretti AS, Pose E, et al. Renal Replacement Therapy for Acute Kidney Injury in Severe Alcohol-Associated Hepatitis as a Bridge to Transplant or Recovery. Dig Dis Sci. 2022 Feb;67(2):697-707. DOI: 10.1007/s10620-021-06864-z.
Regner KR, Kanduri SR, Velez JCQ. Management of AKI in patients with cirrhosis. Curr Treat Options Gastroenterol. 2022;20(3):295–315. DOI: 10.1007/s11938-022-00398-7
Levitsky J, Asrani SK, Klintmalm G, et al. Discovery and validation of a biomarker model (PRESERVE) predictive of renal outcomes after liver transplantation. Hepatology 2020;71(5):1775–86. DOI: 10.1002/hep.30939
Angeli P, Garcia-Tsao G, Nadim MK, et al. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol [Internet]. 2019. DOI: 10.1016/j.jhep.2019.07.002.
Velez JCQ, Latt N, Rodby RA. Pathophysiology of hepatorenal syndrome. Advances in Kidney Disease and Health [Internet]. 2024;31(2):87–99. DOI: 10.1053/j.akdh.2024.01.002
Guixé-Muntet S, Quesada-Vázquez S, Gracia-Sancho J. Pathophysiology and therapeutic options for cirrhotic portal hypertension. Lancet Gastroenterol Hepatol. 2024; Disponible en: http://dx.doi.org/10.1016/s2468-1253(23)00438-7
Kanduri SR, Velez JCQ. Kidney dysfunction in the setting of liver failure: Core curriculum 2024. Am J Kidney Dis. 2024;83(3):386–401. DOI: 10.1053/j.ajkd.2023.08.013
Iwakiri Y, Trebicka J. Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy. JHEP Rep 2021;3(4):100316. DOI: 10.1016/j.jhepr.2021.100316
Simbrunner B, Trauner M, Reiberger T, et al. Recent advances in the understanding and management of hepatorenal syndrome. Fac Rev 2021 DOI: 10.12703/r/10-48
Kazory A, Ronco C. Hepatorenal syndrome or hepatocardiorenal syndrome: Revisiting basic concepts in view of emerging data. Cardiorenal Med 2019. DOI: 10.1159/000492791
Gunarathne LS, Rajapaksha H, Shackel N, et al. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World J Gastroenterol. 2020; 26(40):6111–40. DOI: 10.3748/wjg.v26.i40.6111
Huang Y, Cai J, Ha F, et al. Characteristics of acute kidney injury and its impact on outcome in patients with acute-on-chronic liver failure. BMC Gastroenterol. 2022;22(1). DOI: 10.1186/s12876-022-02316-8
Ojeda-Yuren AS, Cerda-Reyes E, Herrero-Maceda MR, et al. An integrated review of the hepatorenal syndrome. Ann Hepatol. 2021;22(100236):100236. DOI: 10.1016/j.aohep.2020.07.008
Trebicka J, Hernaez R, Shawcross DL, et al. Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers. Gut 2024; 73(6):1015–24. DOI: 10.1136/gutjnl-2023-330584
Adebayo D, Wong F. Recent advances in ascites and acute kidney injury management in cirrhosis. Aliment Pharmacol Ther. 2024; 59(10):1196–211.
Caraceni P, Riggio O, Angeli P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet. 2018; 391(10138):2417–29. DOI: 10.1016/S0140-6736(18)30840-7
Tufoni M, Zaccherini G, Caraceni P. Prolonged albumin administration in patients with decompensated cirrhosis: the amount makes the difference. Ann Transl Med. 2019; 7(S6):S201–S201. DOI: 10.21037/atm.2019.07.16
Jagdish RK, Roy A, Kumar K, et al. Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure. Front Med (Lausanne) 2023;10. DOI: 10.3389/fmed.2023.1060073
Garcia-Tsao G, Abraldes JG, Rich NE, et al. AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis: Expert review. Gastroenterology. 2024;166(1):202–10. DOI: 10.1053/j.gastro.2023.10.016
Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: A review. JAMA. 2023; 329(18):1589. DOI: 10.1001/jama.2023.5997
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020;m2687. DOI: 10.1136/bmj.m2687
Wong F, Pappas SC, Curry MP, et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome. N Engl J Med. 2021;384(9):818–28. DOI: 10.1056/NEJMoa2008290
Arora V, Maiwall R, Rajan V, et al. Terlipressin is superior to noradrenaline in the management of acute kidney injury in acute on chronic liver failure. Hepatology. 2020 [citado el 24 de mayo de 2024];71(2):600–10. DOI: 10.1002/hep.30208
García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G. Where does TIPS fit in the management of patients with cirrhosis? JHEP Rep. 2020;2(4):100122. DOI: 10.1016/j.jhepr.2020.100122
Sanyal AJ, Genning C, Reddy KR, et al. The North American study for the treatment of refractory ascites. Gastroenterology 2003;124. DOI: 10.1053/gast.2003.50088
Sellers CM, Nezami N, Schilsky ML, et al. Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: Current state and future directions. Transplant Rev. 2019;33(2):64–71. DOI: 10.1016/j.trre.2018.10.004
Song T, Rössle M, He F, et a. Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis. Dig Liver Dis 2018 50(4):323–30. DOI: 10.1016/j.dld.2018.01.123
Allegretti AS, Parada XV, Eneanya ND, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):16-25. DOI: 10.2215/CJN.03610417.
Nadim MK, Sung RS, Davis CL, et al. Simultaneous liver–kidney transplantation summit: Current state and future directions. Am J Transplant. 2012;12(11):2901–8. DOI: 10.1111/j.1600-6143.2012.04190.x
Jones BE, Allegretti AS, Pose E, et al. Renal Replacement Therapy for Acute Kidney Injury in Severe Alcohol-Associated Hepatitis as a Bridge to Transplant or Recovery. Dig Dis Sci. 2022 Feb;67(2):697-707. DOI: 10.1007/s10620-021-06864-z.
Regner KR, Kanduri SR, Velez JCQ. Management of AKI in patients with cirrhosis. Curr Treat Options Gastroenterol. 2022;20(3):295–315. DOI: 10.1007/s11938-022-00398-7
Levitsky J, Asrani SK, Klintmalm G, et al. Discovery and validation of a biomarker model (PRESERVE) predictive of renal outcomes after liver transplantation. Hepatology 2020;71(5):1775–86. DOI: 10.1002/hep.30939