What is Hepatorenal Syndrome? Clinical features, Investigation, Diagnosis, Treatment of Hepatorenal Syndrome
Hepatorenal Syndrome:
People who are suffering from the disease-related liver are aware of diseases like hepatorenal Syndrome.
Patients who are suffering from ascites with cirrhosis are a higher chance of hepatorenal Syndrome.
In this syndrome, functional azotemia was seen without any renal pathology in patients with advanced cirrhosis or acute liver failure.
AZOTEMIA MEANS A HIGHER LEVEL OF NITROGEN PRODUCT AND URINE PRODUCT IN THE BLOOD.
If you want to know how this syndrome affects our renal function then here we go simple as possible.
First of all severe peripheral vasodilation is seen due to nitric oxide which I present in the blood (AZOTEMIA) which leads reduction in the effective blood volume and hypotension.
Now hypotension activities the homeostasis mechanism and rennin-angiotensin-aldosterone system which leads to vasoconstriction of the renal vessel.
Increased preglomerular vascular resistance directs the flow of blood away from the renal Cortex which leads reduction in GFR (Glomerular filtration rate).
👉 Some of the factors which trigger the hepatorenal Syndrome (HRS)
• Gastrointestinal bleeding
• Aggressive paracentesis
• Diuretic therapy
• Sepsis including spontaneous bacterial peritonitis (SBP)
• Diarrhoea
👉 THERE IS 2 TYPES OF HEPATORENAL SYNDROME (HRS)
TYPE 1 :
• Oliguria (Creatinine >2.5 mg/dl)
• Poor prognosis
• Precipitated by SBP
• Die within 10 weeks after onset of renal failure
TYPE 2 :
• Reduction in GFR (Creatinine >1.5 mg/dl)
• Better prognosis than type 1
• Usually seen in patients with refractory ascites
• Median survival is 3-6 months
👉 CLINICAL FEATURES SEEN IN HEPATORENAL SYNDROME (HRS)
Developed in advanced cirrhosis with ascites.
- Anorexia
- Weakness
- Fatigue
- Oliguria
- Nausea
- Vomiting
- Thirst
- Terminally coma deepens and hypotension develops
👉 INVESTIGATION AND REPORTS FOR HEPATORENAL SYNDROME (HRS)
• Urea and Creatinine levels are High
• serum sodium: less than 130 mEq/L
• urine sodium excretion : <10mEq/day
• urinalysis is normal
• Urine: plasma ratio is more than 1.5
👉HOW TO DIAGNOSIS HEPATORENAL SYNDROME (HRS)?
Some of the following must be present to diagnose HRS.
• Cirrhosis with ascites
• Serum Creatinine >1.5mg/dl
• absence of shock
•no current or past treatment by nephrotoxic drugs
• no improvement of serum creatinine
• absence of parenchymal kidney disease
👉 TREATMENT OF HRS (TREATMENT OF HEPATORENAL SYNDROME)
• First we will talk about HRS prevention :
Avoid over vigorous diuretic therapy
Slow treatment of ascites
Early recognition of electrolyte imbalance, hemorrhage, or infection
IF HEPATORENAL SYNDROME (HRS) ALREADY OCCURRED THEN?
- Stop diuretic therapy
- Correct hypovolemia
- Treat infection like SBP
- albumin infusion + terlipressin is effective for short term therapy
- Midodrine + octreotide and the intravenous album are also currently used.
- Renal replacement therapy
LIVER TRANSPLANTATION IS THE TREATMENT OF CHOICE.
NOTE: Here given information is just for knowledge and study material. If any discomfort is found in the body then please consult with a doctor.
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