Hepatorenal Syndrome
HRS-related hospital admissions have risen over the past decade and have led to increased inpatient costs, yet understanding of the overall economic burden of this serious condition has remained limited - Mallinckrodt Pharmaceuticals
image by: American Journal of Kidney Diseases
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Hepatorenal Syndrome and Novel Advances in its Management
Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology.
Hepatorenal syndrome is classified into 2 types: type-1 HRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); type-2 HRS has a more stable kidney failure, with a median survival of 6 months; its main clinical manifestation is refractory ascites.
The most appropriate therapy for HRS is liver transplantation but only a minority of HRS patients undergo the procedure due to the high mortality; survival among liver…
Resources
#NephMadness 2019: Hepatorenal Region
Patients with liver failure are sick. Patients with acute kidney injury (AKI) are sick. Put the two together and you have a fine mess. For the first time NephMadness is taking these two conditions and putting them into their own region.
Hepatorenal syndrome: Update on diagnosis and therapy
Hepatorenal syndrome (HRS) is a life-threatening complication present in very advanced liver cirrhosis. This manuscript addresses many recent advances in this field, including the recent change in the definition of HRS according to acute kidney injury criteria, the potential consequences of the adoption of this new definition, and the use of biomarkers to help in the diagnostic algorithm.
Does my patient have hepatorenal syndrome?
This is intended to provide a quick list for diagnosis of HRS, since HRS is a diagnosis of exclusion and should only be made once other conditions are “ruled out.” HRS is a clinical diagnosis, and there is no one perfectly sensitive or specific test.
Hepatorenal Syndrome (HRS)
What causes renal dysfunction in cirrhotic patients? Is it an early, mid, or late finding in the natural history of the disease? Why are there two types of hepatorenal syndrome, and which one is which? How can you tell the difference between hepatorenal syndrome and acute tubular necrosis (ATN)?
Hepatorenal Syndrome: A New Era
Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial.
Hepatorenal syndrome: current diagnostic and therapeutic concepts
Of the various complications in liver cirrhosis including intestinal bleeding, ascites and hepatocellular carcinoma, the rapidly progressive form of kidney dysfunction in cirrhosis, i.e. hepatorenal syndrome type 1, still carries the worst prognosis.
Hepatorenal syndrome: some help from the renal service
Dialysis typically only offered when liver recovery is expected or possible (acute liver injury) or when liver transplant is a valid option. Conventional dialysis in often proves challenging as hypotension is common in patients with liver failure.
Updates on Hepato-Renal Syndrome
Hepato-Renal Syndrome (HRS) is one of the most detrimental conditions in patients with end stage liver failure. Historically, HRS was considered a terminal disease associated with cirrhosis and was termed “liver-death syndrome”. Furthermore, despite the improved understanding of pathophysiology and the reversibility of renal dysfunction in HRS, mortality remains extremely high especially for type 1 HRS
Hepatorenal Syndrome and Novel Advances in its Management
Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology. HRS is a potentially reversible form of renal failure that occurs in patients with cirrhosis and ascites as well as in patients with acute liver failure.
Clinical Advisor
Hepatorenal syndrome (HRS) is a potentially reversible form of renal failure seen in patients with advance liver disease and occasionally in acute fulminant liver failure. HRS is a diagnosis of exclusion and it is diagnosed when all other causes of renal failure have been ruled out.
Horses and Zebras
Often, these patients deteriorate. If they are not candidates for liver transplantation, then aggressive medical therapy may be their only hope – sometimes that fails and palliation/symptom control needs to be considered. Many nephrologists do not offer dialytic therapy to these patients because their underlying liver condition is not reversible. Occasionally, patients are transplant candidates and may be dialyzed as a bridge to transplantation.
Life in the Fastlane
Hepatorenal Syndrome = profound oliguria and Na+ retention in the setting of severe liver dysfunction (cirrhosis or fulminant liver failure) •usually fatal unless liver transplant performed. •RRT can prevent advancement of condition
NORD
Hepatorenal syndrome (HRS) is a form of impaired kidney function that occurs in individuals with advanced liver disease. Individuals with hepatorenal syndrome do not have any identifiable cause of kidney dysfunction and the kidneys themselves are not structural damaged. Therefore, hepatorenal syndrome may be referred as a “functional” form of kidney impairment.
Patient
A complication of end-stage liver disease which occurs in patients who have chronic liver dysfunction with cirrhosis and ascites and also in acute liver failure. In hepatorenal syndrome (HRS) there is impaired renal function which is often precipitated by events lowering blood pressure. A number of factors can precipitate hepatorenal syndrome, including infections, alcoholic hepatitis and bleeding.
Siriasis
I did some research, which I thought was interesting. The mechanism of hepatorenal syndrome is multifaceted and still not fully elucidated. However, following the development of cirrhosis and portal hypertension, there is increased pressure within the splanchnic circulation, leading to increased production of nitric oxide. This causes local vasodilation of the splanchnic vasculature and pooling of blood. As such, there is reduced effective arterial blood volume, which kicks in the RAAS system. Consequently, there is renal vasoconstriction and decreased GFR.
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