Hepatorenal Syndrome

Question 1

What is hepatorenal syndrome?

Answer 1

Rapid deterioration in kidney function in individuals with liver failure.

Question 2

What is the pathophysiology of hepatorenal syndrome?

Answer 2

1. Vasoactive mediators cause splanchnic vasodilation which reduces sympathetic vascular resistance.
2. Causes ‘underfilling’ of the kidneys.
3. Activation of RAAS, renal vasoconstriction, not enough to counteract splanchnic vasodilation.

Question 3

What is the management for hepatorenal syndrome?

Answer 3

1. Liver transplant ideally
2. Vasopressin analogues - Terlipressin
3. Volume expansion with 20% albumin
4. Transjugular intrahepatic portosystemic shunt (TIPS)