Hepatorenal Syndrome

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

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Liver failure with portal hypertension and ascites

Etiology and pathogenesis

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

  • 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

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

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

Terapy


References

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