Hepatorenal syndrome differential diagnosis

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

Overview

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

Differentiating Hepatorenal Syndrome from other Diseases

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:

Variables Kidney injury associated with infection Prerenal acute kidney injury Hepatorenal syndrome Parenchymal renal disease
Mechanism

Causes

Infections, including SBP Hypovolumia due:

gastrointestinal fluid losses

bleeding

diuretic

nonsteroidal anti-inflammatory drug

Splanic vasodalation due to Nitic oxide Aminoglycoside therapy

Radiocontrast agent

Sepsis

Diagnostic clue History of fever

Blood cultures

Ascetic cultures

History of:

Bleeding

low blood pressure

Intake of NAISD

Diagnosis of exclusion:

Liver failure + Renal failure

no apparent cause for the acute kidney injury

No improvement on removing

nephrotoxic agent

repleating fluid loss

History of:

Infections

Injection of Dye

intake of nephrotoxic agent

Prognosis Good Good Poor Good

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