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Hepatorenal syndrome Causes and Risks:
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. This is often exhibited by decreased urine production . Nitrogen-containing waste products accumulate in the blood stream ( azotemia ).
The exact cause of hepatorenal syndrome is unknown. There is an unclear relationship between the liver and the kidney, but in hepatorenal syndrome there is a drastic reduction in blood flow to the kidneys. The kidney structure remains essentially normal and the kidneys often will instantly function well if the liver disease is corrected (for example, by liver transplantation).
The disorder occurs in about 4 out of 10,000 people. It may be a sign of impending death caused by the accumulated effects of liver damage and kidney failure in people with acute liver failure, cirrhosis , or alcoholic hepatitis . It is diagnosed when other causes of kidney failure are ruled out.
Risk factors include cirrhosis, alcoholic hepatitis, acute liver failure, recent abdominal paracentesis , gastrointestinal bleeding, use of diuretics, and the presence of orthostatic hypotension ( blood pressure falls when the person rises or suddenly changes position).
Prevention:
It is not yet known how to prevent this disorder.
Symptoms:
Signs and Tests:
Examination may reveal hepatic encephalopathy , jaundice , ascites , and other signs of liver failure along with the decrease in kidney functioning. Deep tendon reflexes are increased and abnormal reflexes may be present, indicating damage to the nervous system. The abdomen is dull on examination by tapping with the tips of the fingers ( percussion ), often with a visible fluid wave when examined by touch ( palpation ). There may be increased breast tissue, decreased testicular size, lesions (spider telangiectasia) on the skin, or other signs of liver failure.
Liver failure may be indicated by: An EEG may be performed if signs of hepatic encephalopathy are present.
Kidney failure may be indicated by:
Treatment:
Treatment is directed to improving liver function, if possible, and to ensuring that circulating blood volume and cardiac output (heart pumping action) are adequate. The disorder is generally treated in the same manner as kidney failure from any cause. All unnecessary drugs (particularly neomycin, NSAIDS, and diuretics) are stopped. Dialysis may improve symptoms.
Surgical placement of a shunt from the abdominal space (peritoneum) to the jugular vein or superior vena cava (called a Levine shunt) may reduce ascites and reverse some of the symptoms of kidney failure.
Prognosis:
The probable outcome is poor. Death commonly occurs as a result of secondary infections or hemorrhage.
Complications:
Call Your Healthcare Provider:
This disorder most often is diagnosed in the hospital during treatment for a liver disorder.
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