Hepatorenal syndrome - Causes, symptoms and treatment. MF.

Hepatorenal syndrome is a serious complication of progressive liver damage, in which there is a development of renal failure in the absence of clinical, laboratory or anatomical signs of any other causes of kidney dysfunction. Such renal failure is usually accompanied by oliguria, the presence of a normal urine sediment and a low concentration of sodium in the urine( less than 10 mmol / l).The disease develops with advanced liver cirrhosis complicated by jaundice, ascites and hepatic encephalopathy. Sometimes this syndrome can be a complication of fulminant hepatitis.

The mechanism of this type of renal failure is unknown. The absence of persistent histopathological changes in the kidneys of patients and the restoration of normal kidney function in cases where the kidneys suffering from hepatorenal donor syndrome are transplanted to recipients with healthy liver suggests that this disorder is of a functional nature.

Treatment of hepatorenal syndrome

Treatment of patients with hepatorenal syndrome usually is unsuccessful. When treating patients with cirrhosis of the liver, care should be taken not to cause a significant change in the volume of intravascular fluid through laparocentesis or aggressive diuresis, i.e., procedures that can accelerate the development of hepatorenal syndrome. Because this syndrome mimics prerenal azotemia, a cautious attempt to increase the volume of intravascular fluid can be considered justified. In some cases, the kidney function recovered after portocaval shunting of the imposition of an abdominal-venous shunt( Leveen) or prolonged hemodialysis. However, these treatments have not been adequately studied in controlled studies. The superposition of the abdominal-venous shunt can be associated with the development of peritonitis, intravascular coagulation and stagnation of blood in the lungs.

Improvement of liver function is often accompanied by simultaneous improvement of kidney function. Every effort should be made to ensure that there are no more specific and amenable causes of simultaneous liver and kidney dysfunction such as infectious diseases( leptospirosis hepatitis accompanied by immune complex disease), toxins( aminoglycosides, carbon tetrachloride) and circulatory disorders( severe heart failure,shock).It should also be borne in mind that those suffering from jaundice and liver disease are particularly sensitive to acute necrosis of the renal tubules.