Hepatorenal syndrome.
Hepatorenal syndrome is a life-threatening complication occurring commonly in cirrhosis liver and rarely in acute liver failure. It can be precipitated by shock, infection, surgery, large volume paracentesis or nephrotoxic drugs. Type I hepatorenal syndrome which usually develops over acute liver failure is rapidly progressive and has poor outcome. Type II hepatorenal syndrome is usually associated with refractory ascites and is slowly progressive with relatively good prognosis. Peripheral vasodilation with intrarenal vasoconstriction is the main pathophysiologic change. Diagnostic criteria, ascertained by international ascites club, is helpful to reach at a proper diagnosis. Management includes pharmacologic therapy to induce splanchnic vasoconstriction which improve renal circulation. Dopamine, vasopressin analogs (ornipressin and terlipressin), midodrine, noradrenaline have been used mainly as a bridge to the liver transplant or in anticipation of improvement in hepatic function. The molecular adsorbent recycling system (MARS) have been recently used in patients with hepatorenal syndrome. Transjugular intrahepatic portosystemic shunt is also another modality which has been used as a bridge to liver transplant in such patients.
Biswas
K D
KD
Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005.
Jain
A K
AK
D001201:Ascites / Q000150:complications; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D012079:Renal Circulation / Q000502:physiology; D017582:Renal Replacement Therapy; D013152:Splanchnic Circulation / Q000502:physiology; D014661:Vasoconstriction / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014664:Vasodilation / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents