Hepatorenal syndrome overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sunny Kumar MD [2], Mehrian Jafarizade, M.D [3]

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 in to two types: type 1 rapidly progressive and type 2 HRS, slowly progressive.

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

Differentiating Hepatorenal syndrome from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

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