Ascites (hepatorenal syndrome)

Question 1

What is the ideal treatment for hepatorenal syndrome?

Answer 1

The ideal treatment is liver transplantation, but patients are often too unwell to have surgery and there is a shortage of donors.

Question 2

What causes the underfilling of the kidneys in hepatorenal syndrome?

Answer 2

Vasoactive mediators cause splanchnic vasodilation, which reduces systemic vascular resistance, leading to underfilling of the kidneys.

Question 3

What activates the renin-angiotensin-aldosterone system in hepatorenal syndrome?

Answer 3

The juxtaglomerular apparatus senses the underfilling of the kidneys and activates the renin-angiotensin-aldosterone system.

Question 4

What are the two types of hepatorenal syndrome?

Answer 4

Type 1 HRS and Type 2 HRS.

Question 5

Describe Type 1 hepatorenal syndrome.

Answer 5

Type 1 HRS is rapidly progressive, with a doubling of serum creatinine to > 221 µmol/L or a halving of creatinine clearance to less than 20 ml/min over less than 2 weeks. It has a very poor prognosis.

Question 6

Describe Type 2 hepatorenal syndrome.

Answer 6

Type 2 HRS is slowly progressive. The prognosis is poor, but patients may live for longer.

Question 7

What are some management options for hepatorenal syndrome?

Answer 7

Management options include vasopressin analogues (e.g., terlipressin), volume expansion with 20% albumin, and transjugular intrahepatic portosystemic shunt.

Question 8

How do vasopressin analogues help in hepatorenal syndrome?

Answer 8

They work by causing vasoconstriction of the splanchnic circulation.

Question 9

Answer 9