Hepatorenal syndrome (patient information): Difference between revisions

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{{Hepatorenal syndrome (patient information)}}
{{Hepatorenal syndrome (patient information)}}


{{CMG}}; '''Assistant Editor-in-Chief:''' Meagan E. Doherty
{{CMG}}; '''Assistant Editor-in-Chief:''' Meagan E. Doherty; {{SKA}}


==Overview==
==Overview==
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* [[Abdominal swelling]]
* [[Abdominal swelling]]
* Change in mental status
* Change in mental status
** Confusion
** [[Confusion]]
** [[Delirium]]
** [[Delirium]]
** [[Dementia]]
** [[Dementia]]
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* Decreased urine production
* Decreased urine production
* [[Nausea]] and [[vomiting]]
* [[Nausea]] and [[vomiting]]
* Weight gain
* [[Weight gain]]
* Yellow skin
* Yellow skin


Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome.  They include the following:
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of [[hepatorenal syndrome]].  They include the following:
*[[Renal failure|Pre-renal failure]]:  Pre-renal failure usually responds to treatment with intravenous fluids, resulting in reduction in serum [[creatinine]] and the excretion of sodium.<ref>Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Scholmerich J. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996 Jan;23(1):164-76. PMID 8550036</ref>
*[[Renal failure|Pre-renal failure]]:  Pre-renal failure usually responds to treatment with intravenous fluids, resulting in reduction in serum [[creatinine]] and the excretion of sodium.<ref>Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Scholmerich J. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996 Jan;23(1):164-76. PMID 8550036</ref>
*[[Acute tubular necrosis]] (ATN): This can be difficult to confidently diagnose.  It may be an inability to concentrate the urine, if any is being produced. The urine sediment should be bland, microscopy may show [[hyaline cast]]s. ATN may recover with supportive treatment only or progress to [[end-stage renal failure]]. In cirrhosis, urinary sodium is not a reliable guide to the development of ATN, as [[fractional sodium excretion]] may stay below 1 percent, due to the gradual worsening of renal [[ischaemia]].
*[[Acute tubular necrosis]] ([[ATN]]): This can be difficult to confidently diagnose.  It may be an inability to concentrate the urine, if any is being produced. The urine sediment should be bland, microscopy may show [[hyaline cast]]s. ATN may recover with supportive treatment only or progress to [[end-stage renal failure]]. In cirrhosis, urinary sodium is not a reliable guide to the development of ATN, as [[fractional sodium excretion]] may stay below 1 percent, due to the gradual worsening of renal [[ischaemia]].
*Other causes may include [[glomerulonephritis|glomerular disease]] secondary to [[Hepatitis B]] or [[Hepatitis C]],<ref>Han SH.  Extrahepatic manifestations of chronic hepatitis B.  ''Clin Liver Dis.'' 2004 May;8(2):403-18.  PMID 15481347</ref> drug toxicity (notably [[gentamicin]]) or [[Radiocontrast|contrast nephropathy]].
*Other causes may include [[glomerulonephritis|glomerular disease]] secondary to [[Hepatitis B]] or [[Hepatitis C]],<ref>Han SH.  Extrahepatic manifestations of chronic hepatitis B.  ''Clin Liver Dis.'' 2004 May;8(2):403-18.  PMID 15481347</ref> drug toxicity (notably [[gentamicin]]) or [[Radiocontrast|contrast nephropathy]].


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==Sources==
==Sources==
*http://www.nlm.nih.gov/medlineplus/ency/article/000489.htm
*http://www.nlm.nih.gov/medlineplus/ency/article/000489.htm
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[[Category:Patient information]]
[[Category:Patient information]]
[[Category:Mature chapter]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology patient information]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Nephrology patient information]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine patient information]]
[[Category:Overview complete]]
[[Category:For review]]


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Latest revision as of 19:20, 21 December 2017

For the WikiDoc page for this topic, click here

Hepatorenal syndrome

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Hepatorenal syndrome?

What to expect (Outlook/Prognosis)?

Possible complications

Hepatorenal syndrome On the Web

Ongoing Trials at Clinical Trials.gov

Images of Hepatorenal syndrome

Videos on Hepatorenal syndrome

FDA on Hepatorenal syndrome

CDC on Hepatorenal syndrome

Hepatorenal syndrome in the news

Blogs on Hepatorenal syndrome

Directions to Hospitals Treating Hepatorenal syndrome

Risk calculators and risk factors for Hepatorenal syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Meagan E. Doherty; Sunny Kumar MD [2]

Overview

Hepatorenal syndrome is a condition in which the kidneys fail suddenly in a person with cirrhosis of the liver. It is a serious complication of cirrhosis.

What are the symptoms of Hepatorenal syndrome?

Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:

What causes Hepatorenal syndrome?

Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. Because less urine is removed from the body, nitrogen-containing waste products build up in the bloodstream (azotemia).

Who is at highest risk?

The disorder occurs in up to 10% of patients hospitalized with liver failure. It is caused by the built-up effects of liver damage and kidney failure in people with:

Other risk factors include:

When to seek urgent medical care?

This disorder most often is diagnosed in the hospital during treatment for a liver disorder.

Diagnosis

This condition is diagnosed when other causes of kidney failure are ruled out.

A physical examination will not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease:

Other signs include:

  • Abnormal reflexes
  • Decreased testicle size
  • Dull sound in the abdomen when tapped with the tips of the fingers, and visible fluid wave when examined by feel
  • Increased breast tissue
  • Sores (lesions) on the skin

The following may be signs of kidney failure:

The following may be signs of liver failure:

Treatment options

Treatment aims to improve liver function and ensure that there is enough blood in the body and the heart is pumping adequately.

The disorder is generally treated in the same way as kidney failure from any other cause.

Prevention of Hepatorenal syndrome

Intravenous albumin: A randomized controlled trial found that intravenous albumin on the day of admission and on hospital day 3 can reduce renal impairment.[3]

Where to find medical care for Hepatorenal syndrome?

Directions to Hospitals Treating Hepatorenal syndrome

What to expect (Outlook/Prognosis)?

The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.

Possible complications

Sources

  1. Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Scholmerich J. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996 Jan;23(1):164-76. PMID 8550036
  2. Han SH. Extrahepatic manifestations of chronic hepatitis B. Clin Liver Dis. 2004 May;8(2):403-18. PMID 15481347
  3. Sort P, Navasa M, Arroyo V, et al (1999). "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis". N. Engl. J. Med. 341 (6): 403-9. PMID 10432325


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