Hepatorenal Syndrome

The term Hepatorenal syndrome is used to describe kidney failure that proceeds progressively. People with severe liver disease like cirrhosis and acute liver failure can get this disorder. Toxins begin to accumulate slowly in the body due to reduced function of kidneys, leading to liver failure. The symptoms of HRS are very mild or almost no signs are evident till the disease has progressed rapidly. The main cause of HRS is acute liver problems and cirrhosis. There is no cure for this disorder and often people would die within 2-4 weeks after diagnosed with this syndrome.

Types :

Hepatorenal syndrome is classified into two types.

  1. HRS 1 or Type 1 syndrome kidney failure is rapid and acute. This builds up plenty of creatinine in blood.
  2. In Type 2 HRS, kidney failure is slow and gradual. The damage to the kidneys occurs as a process and in this case the patient can be saved if promptly diagnosed.

Who are at risk?

People with liver cirrhosis are at high risk of developing Hepatorenal syndrome. Those who are hospitalized for long periods for liver problems are likely to develop HRS. 1 out of 10 people with severe liver problems can develop this disorder. People with prolonged infection, people who are using diuretics for long, people with gastrointestinal problems and bleeding, and those with orthostatic hypotension (having sudden fall of BP while changing position) are at high risk of getting HRS.

Causes :

People with liver problems only develop Hepatorenal syndrome. Due to intense liver problem, the kidney may not be able to function normally, leading to accumulation of waste products and toxin in the blood. Those who are alcoholic and diagnosed with cirrhosis are more likely to get this syndrome than others.

Symptoms :

Generally the symptoms are very subtle in case of people with type 1 HRS. Those with chronic or gradual liver problems may not show any signs until the disease has progressed. People with existing liver problems should be careful and report any changes to the physician immediately. They may show signs of confusion or mental instability, nausea, vomiting, reduced urine output, sudden increase in weight, dementia and swelling of abdomen. Abdominal swelling can occur due to accumulation of waste products and fluids and the color of urine can be very dark. It can also cause muscle jerks and in some causes jaundice (yellow coloration of skin and eyes) may be present.

Tests :

Based on the symptoms your doctor will look for liver problems. Physical exam alone cannot reveal any kidney disease. He may look for abnormal reflex, change in skin color, fluid accumulation in the abdomen and sores on the skin which can be indication of liver failure.

For people who are not alcoholic, liver damage can occur due to other reasons also. Your doctor will have to conduct other tests to find out the other causes of liver damage. Blood culture and urine analysis is to be done to check the levels of sodium and creatinine to diagnose kidney problem.

Treatment :

The ultimate goal of treating patients with HRS is to repair the liver damage and kidney damage equally. Your doctor would stop all diuretics (water pills), NSAID drugs immediately. He would recommend dialysis for increasing the kidney function. Liver transplantation is the first line treatment for patients diagnosed with Hepatorenal syndrome. Vasoconstrictor drugs like omipressin and terlipressin are prescribed. Dopamine is also effective in reducing the symptoms of kidney failure. Drugs like Misoprostol, Saralasin, and Octapressin have shown improved symptoms.

  • Surgery :

Peritoneovenous shunt PVS is performed for patients diagnosed with type 2 HRS to improve portal hypertension. Liver transplant surgery is ideal for Hepatorenal syndrome but donors may not be readily available.

Prognosis :

The rate of survival with HRS syndrome is very low. But if the person survives with liver transplant he may get extended life for 3-4 years if not developing any complications like secondary infection, organ failure and fluid overload etc.

Prevention :

You cannot prevent HRS but you can always check the condition of your liver regularly with your doctor. Quit drinking since it causes extensive damage to your liver.

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