Skip to main content

Hepatorenal Syndrome

 Hepatorenal Syndrome



OVERVIEW

Hepatorenal syndrome (HRS) is a form of impaired kidney function that occurs in individuals with advanced liver disease. Individuals with hepatorenal syndrome do not have any identifiable cause of kidney dysfunction and the kidneys themselves are not structural damaged. Therefore, hepatorenal syndrome may be referred as a “functional” form of kidney impairment. In fact, if the kidney of an individual with hepatorenal syndrome were to be transplanted into an otherwise healthy individual, it would function normally. Hepatorenal syndrome is classified into to two distinct types. Type I is a rapidly progressive condition that leads to renal failure; type II does not have a rapid course and progresses slowly over weeks to months.

Although the hepatorenal syndrome occurs in individuals with liver disease, the exact cause of the condition is unknown. Researchers have noted that blood circulation is abnormal in individuals with hepatorenal syndrome. The arteries that circulate oxygenated blood from the lungs to the rest of the body (systemic circulation) widen in contrast to the arteries of the kidney, which narrow causing a decrease in the blood flow through the kidney. Many affected individuals also have high blood pressure of the branches of the portal vein (portal hypertension), the main vein that carries blood from the intestines to the liver.

Symptoms

People with hepatorenal syndrome tend to have vague symptoms of general unwellness, such as:

Fatigue.

Nausea.

Stomach ache.

Bad taste in the mouth.

They may also have symptoms of advanced liver disease or liver failure, such as:

Jaundice (yellowing of the whites of the eyes).

Easy bruising and bleeding.

Light-colored poop and dark-colored pee.

Swollen abdomen (due to ascites, enlarged liver or enlarged spleen).

Itchy skin.

Confusion, disorientation or drowsiness (hepatic encephalopathy).

When kidney failure becomes severe, you will notice low urine output.

Causes

Pathophysiology

The exact pathophysiology of hepatorenal syndrome — how it develops as a result of liver disease — is still in debate. We do know that narrowed and constricted blood vessels in the kidneys reduce their blood supply, causing dysfunction. Researchers believe this narrowing may be caused by a combination of factors related to liver disease and liver failure. The most common factor is portal hypertension.

Portal hypertension is high blood pressure in the portal vein that runs through your liver. It causes the vein and its branches throughout your digestive system to widen. Cirrhosis is its most common cause. Cirrhosis can also cause cirrhotic cardiomyopathy, which causes abnormal widening of certain arteries in your body. Complex blood flow dynamics cause some vessels to narrow when others widen.

Precipitating Factors

Other factors associated with liver disease may be possible “triggers” that make HRS more likely to onset. The most common one is spontaneous bacterial peritonitis (SBP), an infection of the peritoneum, the tissues that line your abdomen. SBP is a complication of ascites, which is the accumulation of fluid in your peritoneum. Ascites is a side effect of portal hypertension, which causes your abdominal veins to leak.

Portal hypertension can also cause your veins to break and bleed into your abdominal cavity. Acute blood loss from gastrointestinal bleeding is another possible trigger. So is the overuse of diuretics (“water pills”). Diuretics help clear out accumulated fluid from your body. People with advanced liver disease may take diuretics for symptoms such as ascites or edema, swelling caused by fluid retention.

Diagnosis

Your doctor may first suspect you have this condition during a physical examination. They will look for signs of HRS such as:

swollen breast tissue

sores on the skin

fluid buildup in the abdomen

jaundice

Diagnosing HRS means excluding other causes of kidney failure. This requires a series of blood and urine tests. The tests will help your doctor evaluate your liver and kidney function. In rare cases, HRS can occur in patients whose liver has been damaged by other causes than cirrhosis. If you don’t have cirrhosis, your doctor may order additional tests for viral or alcoholic hepatitis.

Treatment

Medications called vasoconstrictors can help with the low blood pressure caused by HRS. Dialysis may be used to improve kidney symptoms. Dialysis filters harmful wastes, excess salt, and excess water from your blood. It’s performed in a hospital or dialysis clinic. Liver transplants are the most effective treatment for HRS. The waiting list for a liver transplant is long and many people die before a liver is available. If you can get a transplant, your chance of survival improves greatly.

Complications and Long-Term Outlook

HRS is almost always fatal. However, a liver transplant can extend your life. Complications of HRS normally appear during end-stage kidney disease. They include:

fluid overload

secondary infections

organ damage

coma

Preventing Hepatorenal Syndrome

The only certain way to prevent HRS is to keep your liver healthy. To reduce your risk of developing cirrhosis, avoid drinking excessive amounts of alcohol.

You should also try to avoid contracting hepatitis. Hepatitis A and B can be prevented by vaccination. There’s currently no vaccine against hepatitis C. Some measures you can take to prevent hepatitis C include:

washing your hands after shaking hands

having your sex partner get tested for hepatitis C

not sharing needles with anyone

not using illegal drugs

consistently practicing safe sex

Some causes of cirrhosis can’t be prevented. If you’re at risk for developing cirrhosis, your doctor may monitor your liver function regularly. They may also order blood and imaging tests to detect early signs of the condition.

Type of Doctor Department : A Nephrologist

Comments

Post a Comment

Popular posts from this blog

Charge Syndrome

Overview CHARGE syndrome is a recognizable genetic syndrome with known pattern of features. It is an extremely complex syndrome, involving extensive medical and physical difficulties that differ from child to child. CHARGE syndrome is correlated with genetic mutation to CHD7 and the prevalence of CHARGE syndrome is 1:10,000-1:15,000 live births. Babies with CHARGE syndrome are often born with life-threatening birth defects. They spend many months in the hospital and undergo many surgeries and other treatments. Swallowing and breathing problems make life difficult even when they come home. Most have hearing two little girls sitting on a carpet, one girl has a trach and is biting her finger.loss, vision loss, and balance problems that delay their development and communication. Despite these seemingly insurmountable obstacles, children with CHARGE syndrome often far surpass their medical, physical, educational, and social expectations. One of the hidden features of CHARGE syndrome is the ...
7 comments
Read more

Acral Peeling Skin Syndrome

Overview Acral peeling skin syndrome is a skin disorder characterized by painless peeling of the top layer of skin. The term "acral" refers to the fact that the skin peeling in this condition is most apparent on the hands and feet. Occasionally, peeling also occurs on the arms and legs. The peeling is usually evident from birth, although the condition can also begin in childhood or later in life. Skin peeling is made worse by exposure to heat, humidity and other forms of moisture, and friction. The underlying skin may be temporarily red and itchy, but it typically heals without scarring. Acral peeling skin syndrome is not associated with any other health problems. Symptoms The main symptom of APSS is the painless peeling of the skin. Most people can remove this skin by hand, and it may come off in sheets, similar to peeling skin after a sunburn. 1. blistering 2. itching 3. easily removable hairs If a person exposes their skin to heat, sweat, or water, they may notice that the...
Post a Comment
Read more

Sjogren's syndrome

Sjogren's syndrome Overview Sjogren's (SHOW-grins) syndrome is a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased tears and saliva. Although you can develop Sjogren's syndrome at any age, most people are older than 40 at the time of diagnosis. The condition is much more common in women. Treatment focuses on relieving symptoms. Symptoms The two main symptoms of Sjogren's syndrome are: Dry eyes . Your eyes might burn, itch or feel gritty — as if there's sand in them. Dry mouth. Your mouth might feel like it's full of cotton, making it difficult to swallow or speak. Some people with Sjogren's syndrome also have one or more of the following: Joint pain, swel...
Post a Comment
Read more