Hepatorenal syndrome: Difference between revisions
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Latest revision as of 11:00, 27 August 2024
Hepatorenal syndrome is "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."[1]
Classification
- Type I hepatorenal syndrome is more serious and defined as at least a 50 percent lowering of the creatinine clearance to less than 20 mL/min over two weeks or at least a doubling in serum creatinine to greater than 2.5 mg/dL (221 µmol/L).
- Type II hepatorenal syndrome is defined as less severe renal insufficiency than that observed with type I.
Differential diagnosis
Among patients with cirrhosis, more common causes of azotemia than hepatorenal syndrome are:[2]
- pre-renal failure (27.4%)
- renal failure induced by infection (14.1%)
- hepatorenal syndrome (7.6%)
Treatment
Octreotide combined with midodrine can help according to a non-randomized study.[3]
Terlipressin, a vasopressin analogue, causes splanchnic vasoconstrition, has helped renal function in two randomized controlled trials.[4][5]
References
- ↑ Anonymous (2024), Hepatorenal syndrome (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Montoliu S, Ballesté B, Planas R, Alvarez MA, Rivera M, Miquel M et al. (2010). "Incidence and prognosis of different types of functional renal failure in cirrhotic patients with ascites.". Clin Gastroenterol Hepatol 8 (7): 616-22; quiz e80. DOI:10.1016/j.cgh.2010.03.029. PMID 20399905. Research Blogging.
- ↑ Esrailian E, Pantangco ER, Kyulo NL, Hu KQ, Runyon BA (2007). "Octreotide/Midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome". Dig. Dis. Sci. 52 (3): 742–8. DOI:10.1007/s10620-006-9312-0. PMID 17235705. Research Blogging.
- ↑ Sanyal AJ et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008 May;134(5):1360-8. Epub 2008 Feb 13. PMID 18471513
- ↑ Martín-Llahí M at al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008 May;134(5):1352-9. Epub 2008 Feb 14. PMID 18471512