The Relationship between Renal Dysfunction and Abnormalities of the Immune System in Patients with Decompensated Cirrhosis

Abstract

In patients with advanced cirrhosis, not only hepatocellular carcinoma but also bacterial infections, such as spontaneous bacterial peritonitis (SBP) or pneumonia, are frequent clinical complications in such immune-compromised patients. These pathologies often progress to renal dysfunction, especially hepatorenal syndrome (HRS). The central pathology of HRS is splanchnic arterial vasodilation and hyperpermeability followed by bacterial translocation (BT). BT induces a severe inflammatory response in the peritoneal lymphoid tissue, with the activation of the immune systems and the long-lasting production of vasoactive mediators that can impair the circulatory function and cause renal failure. Recent studies report that the plasma amino acid imbalance appeared to be related to an abnormality of the immune system in patients with decompensated cirrhosis. This paper can provide a new approach for future studies of the pathology in cirrhotic patients with renal dysfunction.

Figure 1

Pathology of hepatorenal syndrome.

Figure 2

Mechanism of the splanchnic arterial vasodilation and hyperpermeability.

Figure 3

Dysfunction of dendritic cells in patient with cirrhosis.

Figure 4

Free amino acids related to renal function in patients with advanced cirrhosis eGFR are calculated by [8].

Figure 5

The amino acid imbalances influence the function of monocytes in cirrhotic patients with renal dysfunction.