Hepatorenal Syndrome

HEPATORENAL SYNDROME


HEPATORENAL SYNDROME

  • HRS is development of acute renal failure due to severe hepatic (advanced cirrhosis) or bilary disease with jaundice.
  • Low cardiac putput and high plasma rennin predicts development of HRS.
  • Patient develops oliguria, azotaemia and hyponatraemia.

ETIOLOGY-

  • Bile salt sludging in the tubules
  • Absorption of toxins
  • Increase ADH release
  • Hypoperfusion and renal ischaemia
  • Precipitated by surgery, stress

 PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation

Exam Important

PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation
Don’t Forget to Solve all the previous Year Question asked on HEPATORENAL SYNDROME

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