Hepatorenal syndrome
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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
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
Historically, the hepatorenal syndrome was first defined as acute renal failure that occurred in the setting of 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
The classification of hepatorenal syndrome is based on the deteriorating function of kidney.
Pathophysiology
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
The cause of Hepatorenal syndrome (HS) is deteriorating function of liver.
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.
Epidemiology and Demographics
Hepatorenal syndrome (HRS) is common in cirrhotic patients.
Risk Factors
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
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
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 impairment which are seen along with cirrhosis.
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
HRS may develop in two clinical types as an acute and rapidly progressive renal failure (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 transplant.
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies