The management of renal failure in patients with liver disease. Experiences from a district general hospital.
OBJECTIVE
To compare the pre-existing management of patients with Hepatorenal Syndrome (HRS) in the gastroenterology unit of the Royal Alexandra Hospital, Renfrewshire, with the published evidence based studies.


METHODS
A retrospective, 6-month, case record review of patients diagnosed with HRS was performed. An evidence-based protocol for the diagnosis and management of HRS was introduced into the unit, to aid patient treatment prospectively. After 6 months, both compliance with the protocol, and patient outcomes were analysed.


RESULTS
Eleven patients were identified in the first part of the audit cycle, all of whom died. Seven were identified in the second cycle. Two had their renal function successfully corrected and one was discharged from hospital. Renal impairment and staging of liver disease was equivalent in both groups. The second group received more appropriate and aggressive therapy. Alcohol was the causative aetiology of liver disease in all patients.


CONCLUSIONS
Targetted therapy in patients with severe liver disease and HRS can improve renal parameters. Previous studies have shown this to be linked with improved patient outcomes.
Manning
J J
JJ
Department of Gastroenterology, Borders General Hospital, Melrose. johnathan.manning@borders.scot.nhs.uk
Hislop
W S
WS
McPeake
J R
JR
D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D003663:Decision Trees; D005260:Female; D019983:Guideline Adherence; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000628:therapy*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012606:Scotland; D016896:Treatment Outcome