Hepatorenal syndrome

Question 1

Pathophysiology of Hepatorenal syndrome

Answer 1

vasoactive mediators cause splanchnic vasodilation

=> reduces systemic vascular resistance
=> ‘underfilling’ of the kidneys. => activates RAAS system to cause renal vasoconstriction (not enough to counterbalance the splanchnic vasodilation)

Question 2

Difference between Type 1 and Type 2 Hepatorenal syndrome

Answer 2

Type 1 - Rapidly progressive
Doubling of serum creatinine over < 2 weeks
Very poor prognosis

Type 2 - Slowly progressive
Prognosis poor, but patients may live for longer

Question 3

Management of hepatorenal syndrome

Answer 3

1) vasopressin analogues (e.g. Terlipressin)
=> vasocontrict splanchnic circulation

2) volume expansion with 20% albumin
3) TIPPS