Gastroenterology Book

Liver

  • Hepatorenal Syndrome

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Hepatorenal Syndrome

Aka: Hepatorenal Syndrome
  1. See Also
    1. Cirrhosis
  2. Definition
    1. Renal Failure due to Hepatic Cirrhosis
    2. Intrinsic renal disease absent
  3. Epidemiology
    1. Less common in Primary Biliary Cirrhosis
    2. Incidence in Cirrhosis with Ascites
      1. One year 18%
      2. Five years: 39%
  4. Pathophysiology
    1. Arterial vasodilation of splanchnic circulation
    2. Results in underfilling of arterial circulation
  5. Types
    1. Type I Hepatorenal Syndrome
      1. Associated with Spontaneous Bacterial Peritonitis
        1. Occurs in 25% of patients with SBP
      2. Rapid deterioration of Renal Function
        1. Serum Creatinine doubles to >2.5 mg/dl or
        2. Creatinine Clearance <20 ml/minute
      3. Survival
        1. Without treatment: <2 weeks (median)
        2. With Treatment: 10 weeks
    2. Type II Hepatorenal Syndrome
      1. Associated with Diuretic-resistant Ascites
      2. Renal Function declines moderately
        1. Serum Creatinine >1.5 mg/dl
      3. Survival: 3-6 months (median)
  6. Diagnosis
    1. Major Criteria
      1. Liver failure with Portal Hypertension
      2. Decreased Glomerular Filtration Rate (GFR)
        1. Serum Creatinine >1.5 mg/dl or
        2. Creatinine Clearance < 40 ml/min
      3. No alternative causes of Acute Renal Failure
        1. No nephrotoxins
        2. No shock or Sepsis
        3. Urine Protein <500 mg/dl
        4. No parenchymal renal disease by renal ultrasound
        5. No ureteral obstruction by renal ultrasound
      4. Renal Failure refractory to measures
        1. Diuretics withdrawn
        2. Volume expansion: 1.5 Liters Normal Saline
    2. Minor Criteria
      1. Urine volume <500 ml/day
      2. Urine Sodium <10 meq/Liter
      3. Urine Osmolality increased over plasma osmolality
      4. Urine Red Blood Cells <50 per hpf
      5. Serum Sodium <130 mEq/L
  7. Management
    1. Hemodialysis
    2. Avoid Nephrotoxins
    3. Midodrine PO with Octreotide IV
      1. Target: Increase Mean Arterial Pressure >15mmHg
    4. Dopamine 2-4 mcg/kg/min IV

Hepatorenal Syndrome (C0019212)

Definition (MSH) Functional KIDNEY FAILURE in patients with liver disease, usually LIVER CIRRHOSIS or portal hypertension (HYPERTENSION, PORTAL), and in the absence of intrinsic renal disease or kidney abnormality. It is characterized by intense renal vasculature constriction, reduced renal blood flow, OLIGURIA, and sodium retention.
Concepts Disease or Syndrome (T047)
MSH D006530
ICD9 572.4
ICD10 K76.7
SnomedCT 51292008
English Heyd's syndrome, HEPATORENAL SYNDROME, HEYD SYNDROME, SYNDROME HEPATORENAL, Syndrome, Hepatorenal, UROHEPATIC SYNDROME, FAILURE HEPATORENAL, RENAL FAILURE SECONDARY TO LIVER DISEASE <HEPATORENAL SYNDROME>, hepatorenal syndrome, hepato-renal syndrome (diagnosis), hepato-renal syndrome, Hepatorenal Syndrome, Failure hepatorenal, Syndrome hepatorenal, RENAL FAILURE SECONDARY TO LIVER DISEASE HEPATORENAL SYNDROME, Hepatorenal Syndrome [Disease/Finding], hepatorenal failure, Hepatorenal syndrome, Hepatorenal failure, HRF - Hepatorenal failure, Hepatorenal syndrome (disorder), failure; hepatorenal, hepatorenal; failure, hepatorenal; syndrome, syndrome; hepatorenal
Spanish SINDROME HEPATORRENAL, Fallo hepatorrenal, síndrome hepatorrenal (trastorno), síndrome hepatorrenal, Insuficiencia hepatorrenal, Síndrome hepatorrenal, Síndrome Hepatorrenal, Sindrome Hepatorrenal
German HEPATORENALES SYNDROM, Versagen, hepatorenal, Syndrom, hepatorenal, hepatorenales Syndrom, hepatorenales Versagen, Hepatorenales Syndrom
French Défaillances hépatique et rénale, Défaillance hépatorénale, SYNDROME HEPATO-RENAL, Syndrome hépatorénal, Syndrome hépato-rénal
Italian Insufficienza epatorenale, Sindrome epatorenale
Japanese 肝腎不全, 肝腎症候群, ｶﾝｼﾞﾝｼｮｳｺｳｸﾞﾝ, ｶﾝｼﾞﾝﾌｾﾞﾝ
Swedish Hepatorenalt syndrom
Czech hepatorenální syndrom, Funkční selhání ledvin, Hepatorenální syndrom, Hepatorenální selhání
Finnish Hepatorenaalinen oireyhtymä
Russian GEPATORENAL'NYI SINDROM, ГЕПАТОРЕНАЛЬНЫЙ СИНДРОМ
Portuguese SINDROME HEPATORENAL, Insuficiência hepatorrenal, Síndrome hepatorrenal, Síndrome Hepatorrenal
Korean 간신 증후군
Croatian HEPATORENALNI SINDROM
Polish Zespół wątrobowo-nerkowy
Hungarian Hepatorenalis elégtelenség, Hepatorenalis syndroma, Hepatorenalis insufficientia
Dutch falen; hepatorenaal, hepatorenaal; falen, hepatorenaal; syndroom, syndroom; hepatorenaal, hepatorenaal falen, hepatorenaal syndroom, Hepatorenaal syndroom, Syndroom, hepatorenaal
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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