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.

• 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

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