Rosen & Barkin's 5-Minute Emergency Medicine Consult
“Keadey • Richard D. McCormick BASICS DESCRIPTION Renal failure (RF) in patients with acute or chronic liver disease with no other identifiable cause of renal pathology.
Hepatorenal syndrome (HRS) represents significant decline in renal perfusion due to severe liver disease: Type I HRS: Acute form with spontaneous RF in patients with liver disease Rapidly progressive Decrease in creatinine clearance (CrCl) by 50% or doubling of Cr in 2 wk (>2.5) 90% mortality within 3 mo Seen with acute liver fa...ilure or alcoholic hepatitis Oliguric or anuric Type II HRS: Slow course of RF Seen in patients with diuretic resistant ascites Lower mortality rate than type I HRS Hallmarks of HRS: Prerenal disease Reversible renal vasoconstriction and mild systemic hypotension Kidneys have normal histology and structure.
Lack of improvement in renal function after volume expansion Liver disease causes systemic vasodilation with decrease in arterial blood volume: Reflex activation of sympathetic nervous system Activation of rennin–angiotensin–aldosterone system (RAAS) Stimulation of numerous vasoactive substances: Nitric oxide Prostacyclin Atrial natriuretic peptide (ANP) Arachidonic acid metabolites Platelet-activating factor Endothelins Catecholamines Angiotensin II Thromboxane Action of vasoconstrictors prevails over vasodilator effects: Renal hypoperfusion ensues due to renal cortical vasoconstriction.MoreLess
Hepatorenal syndrome (HRS) represents significant decline in renal perfusion due to severe liver disease: Type I HRS: Acute form with spontaneous RF in patients with liver disease Rapidly progressive Decrease in creatinine clearance (CrCl) by 50% or doubling of Cr in 2 wk (>2.5) 90% mortality within 3 mo Seen with acute liver fa...ilure or alcoholic hepatitis Oliguric or anuric Type II HRS: Slow course of RF Seen in patients with diuretic resistant ascites Lower mortality rate than type I HRS Hallmarks of HRS: Prerenal disease Reversible renal vasoconstriction and mild systemic hypotension Kidneys have normal histology and structure.
Lack of improvement in renal function after volume expansion Liver disease causes systemic vasodilation with decrease in arterial blood volume: Reflex activation of sympathetic nervous system Activation of rennin–angiotensin–aldosterone system (RAAS) Stimulation of numerous vasoactive substances: Nitric oxide Prostacyclin Atrial natriuretic peptide (ANP) Arachidonic acid metabolites Platelet-activating factor Endothelins Catecholamines Angiotensin II Thromboxane Action of vasoconstrictors prevails over vasodilator effects: Renal hypoperfusion ensues due to renal cortical vasoconstriction.MoreLess
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