HEPATORENAL SYNDROME

Question 1

Definition

Answer 1

The development of acute kidney injury in a patient who usually has advanced liver disease, either cirrhosis or alcoholic hepatitis

Question 2

Pathophysiology

Answer 2

Marked peripheral vasodilatation —> fall in systemic vascular resistance and effective hypovolemia —> vasoconstriction of the renal circulation with markedly reduced renal perfusion
Absence of other causes of acute kidney injury and lack of improvement after volume expansion (if necessary) and withdrawl of diuretics

Question 3

Diagnosis (3)

Answer 3

• Oliguria
• Rising serum creatinine (over days to weeks)
• Low urine sodium (<10 mmol/L)

Question 4

Prognosis

Answer 4

Poor; renal failure will often respond only if liver function improves