Hepatorenal Syndrome

From WikiLectures

Hepatorenal syndrome is functional kidney failure in liver disease with portal hypertension. It occurs almost exclusively in patients with ascites.

Liver failure with portal hypertension and ascites

Etiology and pathogenesis[edit | edit source]

The basis is systemic circulatory changes in portal hypertension.

  • Renal arterial vasoconstriction (with cortical hypoperfusion) + damage to kidney functions,
  • the basis is systemic circulatory changes in portal hypertension (↓ peripheral vascular resistance, central hypovolemia, sympathetic activation).

Clinical picture[edit | edit source]

  • Type I – rapidly progressive, 2x ↑ serum creatinine within 2 weeks, prognosis is very poor,
  • type II – slowly progressing, renal insufficiency occurs slowly + condition relatively stabilized.

Diagnostics[edit | edit source]

There is no specific test that can diagnose hepatorenal syndrome. Glomerular filtration is usually < 0.66 ml/s (40 ml/min), serum creatinine > 135 μmol/l, sodium in urine < 10 mmol/l, urine osmolality > plasma.

Differential diagnosis[edit | edit source]

  • Organic kidney damage (ATN, etc.).
TIPS (transjugular intrahepatic portosystemic shunt)

Terapy[edit | edit source]


Links[edit | edit source]

Related articles[edit | edit source]

References[edit | edit source]

  • DÍTĚ, P.. Vnitřní lékařství. 2. edition. Galén, 2007. ISBN 978-80-7262-496-6.