Hepatorenal Disorders.
Chest. 2015 Mar 26;
Authors: Al-Khafaji A, Nadim MK, Kellum JA
Abstract
Abstract: Renal dysfunction is common in patients with end-stage liver disease (ESLD) and takes on many forms from acute to chronic renal injury and may involve a variety of mechanisms. Hepatorenal syndrome (HRS) is a specific type of hepatorenal disorders (HRD) with a unique pathophysiology. HRS is characterized by splanchnic arterial vasodilatation and decreased effective intravascular volume that leads to renal vasoconstriction and decreased renal blood flow. The incidence of HRS in relation to other forms of HRD is unknown, however, it is estimated that 35-40 % patients with ESLD and ascites eventually develop the condition. Two subtypes of HRS have been described. Type 1 HRS is rapidly progressive, whereas renal function in type 2 HRS deteriorates slowly over weeks or months. Type 1 HRS may be precipitated by sepsis or acute alcoholic hepatitis and occasionally develops in patients who already have type 2 HRS. Diagnosis of HRS is based on exclusion of other causes of renal dysfunction as there is no specific test available. Definitive treatment of HRS is liver transplantation. As a bridge to liver transplantation, medical management with volume expansion and use of vasoconstrictors is often implemented. Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been attempted at treating hepatorenal syndrome, although there is little evidence of its efficacy compared to standard therapy. Renal replacement therapy (RRT) is often used if the patient is a liver transplant candidate. Artificial liver assist devices are in the research phase.
PMID: 25811649 [PubMed - as supplied by publisher]