Hepatorenal syndrome

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Hepatorenal syndrome

Hepatorenal syndrome is an acute progressive decrease in renal blood flow and functional glomerular filtration rate due to a sharp vasospasm of the cortical layer of the kidneys. Occurs in the terminal stage of liver cirrhosis, severe infectious hepatitis, operations on the liver and biliary tract in the absence of other causes of renal failure. The frequency is up to 32-41% of cases of liver cirrhosis with ascites. The predominant age is over 40 years with alcoholic cirrhosis of the liver, against the background of other liver pathology – at any age. The predominant gender is male.

Etiology

    • Fulminant hepatitis
    • Cirrhosis of the liver with ascites.

Genetic aspects are associated with the risk of the following diseases:

    • Pediatric autosomal recessive polycystic kidney disease
    • Ouantitrypsin deficiency
    • Wilson-Konovalov disease. Risk factors. Decreased BCC in liver cirrhosis
    • Removal of a large volume of fluid during paracentesis
    • Excessive diuresis
    • Blood loss (bleeding from varicose veins of the esophagus or rectum, severe trauma)
    • Prolonged diarrhea (including lactulose-induced)
    • indomitable vomiting
    • bacteremia
    • Decreased venous return in ascites. Pathogenesis
    • Vasoconstriction of the efferent renal arterioles
    • Shunting of blood from the cortex to the medulla
    • Decreased glomerular filtration rate
    • Decreased renal blood flow.

Clinical picture

    • Oliguria
    • Symptoms of hepatitis or cirrhosis of the liver: jaundice, ascites, hepatic encephalopathy, splenomegaly, jellyfish head, spider veins
    • Tachycardia and alternating pulse – often.

Laboratory research

    • An increase in the concentration of urea and creatinine in the blood serum, the ratio of urea to creatinine is more than 30:1
    • The concentration of sodium in the urine is less than 10 mEq / l
    • General urine test – the sediment is not changed. Special studies. Ultrasound of the kidneys – no changes. Differential Diagnosis
    • Heart failure
    • tubular necrosis
    • Prerenal renal failure
    • Postrenal renal failure
    • Interstitial (drug) nephritis.

Treatment:

Diet. With the development of hepatic encephalopathy, a rapid change in diet

    • Exclusion of animal proteins
    • Sharp restriction or complete exclusion of fats
    • The introduction of easily digestible carbohydrates – fruit and berry juices rich in potassium salts (orange, grape, etc.), infusion of dried apricots, apricots, prunes; kissels, compotes
    • Parenteral nutrition (glucose, 0.9% NaCl solution, Ringer solution, vitamins B, B2, B6, B | 2, PP, C, etc.).

General tactics

    • Bed mode
    • Hemodialysis – for patients awaiting liver transplant
    • With hypovolemia – infusion therapy.

Drug therapy

    • Dopamine nbsp; 0.5-3 mcg / kg / min (continuous intravenous infusion for 2-3 hours to 1-4 days). The action stops after 5-10 minutes after the end of the introduction. Large doses of dopamine can cause tachycardia and/or arrhythmia.

Surgical treatment: liver transplantation, portocaval shunts. The prognosis is unfavorable. Survival after liver transplantation in patients with prior HRS is worse than without HRS. Prevention

    • Refusal of alcohol
    • Do not recommend taking NSAIDs, as well as products with a nephrotoxic effect, for example, antibiotic aminoglycosides
    • Loop diuretics should be used sparingly to avoid high diuresis.

Synonyms

    • Hepatonephritis
    • Hepatonephrosis
    • hepatic-renal syndrome
    • Renal-hepatic syndrome

See also Acute renal failure, Hepatic cell failure, Cirrhosis of the liver

ICD. K76.7 Hepatorenal syndrome