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{{Hepatorenal syndrome}}
{{Hepatorenal syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hepatorenal_syndrome]]


'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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{{SK}} Heyd syndrome; HRS.
{{SK}} Heyd syndrome; HRS.


==Overview==
== [[Hepatorenal syndrome overview|Overview]] ==
'''Hepatorenal syndrome''' (HRS) refers to [[acute renal failure]] that occurs in the setting of [[cirrhosis]] or [[fulminant]] [[liver failure]] associated with [[portal hypertension]], usually in the absence of other disease of the [[kidney]] . It is a direct result of changes in the splanchnic and systemic circulation from [[cirrhosis]] or [[fulminant hepatic failure]]. It is usually secondary to trigger events which cause multi-system organ failure.


==Historical Perspective==
==[[Hepatorenal syndrome historical perspective|Historical Perspective]]==
Historically, the hepatorenal syndrome was first defined as acute renal failure that occurred in the setting of [[Bile duct|biliary surgery]]. The syndrome was soon associated with advanced liver disease. It was determined that kidneys transplanted from patients with hepatorenal syndrome were functional, leading to the hypothesis that hepatorenal syndrome was a systemic process as opposed to renal disease, which affects the renal function.


==Classification==
==[[Hepatorenal syndrome pathophysiology|Pathophysiology]]==
The classification of hepato-renal syndrome is based on the deteriorating function of kidney.


==Pathophysiology==
==[[Hepatorenal syndrome causes|Causes]]==
The major pathophysiologic mechanism responsible for the clinical manifestation of [[hepatorenal syndrome]] is renal [[vasoconstriction]]. The hemodynamic disturbances include increased [[cardiac output]], systemic [[vasodilatation]] and low arterial [[blood pressure]]. Thus, renal vasoconstriction occurs even with a normal [[blood volume]] and increased [[cardiac output]].


==Causes==
==[[Hepatorenal syndrome epidemiology and demographics|Epidemiology and Demographics]]==
The cause of Hepatorenal syndrome (HS) is deteriorating function of liver.


==Differentiating Hepatorenal syndrome from other Diseases==
==[[Hepatorenal syndrome risk factors|Risk Factors]]==
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. 


==Epidemiology and Demographics==
==[[Hepatorenal syndrome screening|Screening]]==
Hepatorenal syndrome{HRS} is common in cirrhotic patients


==Risk Factors==
==[[Hepatorenal syndrome differential diagnosis|Differentiating Hepatorenal syndrome from other Diseases]]==
Hepatorenal syndrome [HRS] develops on the background of advanced liver disease. HRS may occur spontaneously mostly in type 2 HRS and may be precipitated in >70% of cases of type 1 HRS.


==Screening==
==[[Hepatorenal syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
There are predictors for patients suffering from liver disease to view chances of development of Hepatorenal syndrome[HRS].
 
==Natural History, Complications and Prognosis==
Hepatorenal syndrome progresses from pre-ascitic stage to frank ascites. [[Multiorgan system failure]], [[infections]] and [[chronic renal failure]] are the most common complication of HPS. Type I HPS carries poorer prognosis compared to type II HPS.


==Diagnosis==
==Diagnosis==
There is no specific marker or imaging test to diagnose patients with hepatorenal syndrome (HRS). For that reason the diagnosis of HRS is based on criteria for excluding other causes of [[Renal insufficiency|renal impairment]] which are seen along with [[cirrhosis]].
[[Hepatorenal syndrome history and symptoms|History and Symptoms]] | [[Hepatorenal syndrome physical examination|Physical Examination]] | [[Hepatorenal syndrome laboratory findings|Laboratory Findings]]
 
[[Hepatorenal syndrome history and symptoms|History and Symptoms]] | [[Hepatorenal syndrome physical examination |Physical Examination]] | [[Hepatorenal syndrome laboratory findings|Laboratory Findings]] | [[Hepatorenal syndrome electrocardiogram|Electrocardiogram]] | [[Hepatorenal syndrome chest x ray|Chest X Ray]] | [[Hepatorenal syndrome CT|CT]] | [[Hepatorenal syndrome MRI|MRI]] | [[Hepatorenal syndrome ultrasound|Ultrasound]] | [[Hepatorenal syndrome other imaging findings|Other Imaging Findings]] | [[Hepatorenal syndrome other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
HRS may develop in two clinical types as an acute and rapidly progressive [[Renal insufficiency|renal failure]] ([[Acute kidney injury|AKI]]-HRS) or as chronic and not progressive [[renal failure]] (CKD-HRS) which can be managed with medications but the end treatment depends on [[Liver transplantation|liver transplant]].
[[Hepatorenal syndrome medical therapy|Medical Therapy]] | [[Hepatorenal syndrome primary prevention|Prevention]] | [[Hepatorenal syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatorenal syndrome future or investigational therapies|Future or Investigational Therapies]]
 
[[Hepatorenal syndrome medical therapy|Medical Therapy]] | [[Hepatorenal syndrome surgery|Surgery]] |  [[Hepatorenal syndrome primary prevention|Primary Prevention]] | [[Hepatorenal syndrome secondary prevention|Secondary Prevention]] | [[Hepatorenal syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatorenal syndrome future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
==Related Chapters==
[[Hepatorenal syndrome case study one|Case #1]]
[[Cirrhosis]]


[[Acute liver failure]]


{{Gastroenterology}}
{{Gastroenterology}}

Latest revision as of 15:27, 26 May 2020

Hepatorenal syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hepatorenal syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hepatorenal syndrome On the Web

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NICE Guidance

FDA on Hepatorenal syndrome

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Hepatorenal syndrome in the news

Blogs on Hepatorenal syndrome

Directions to Hospitals Treating Hepatorenal syndrome

Risk calculators and risk factors for Hepatorenal syndrome

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Synonyms and keywords: Heyd syndrome; HRS.

Overview

Historical Perspective

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Screening

Differentiating Hepatorenal syndrome from other Diseases

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings

Treatment

Medical Therapy | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Related Chapters

Cirrhosis

Acute liver failure

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