- Hepatorenal syndrome refers to the development of kidney impairment in the setting of cirrhosis, portal hypertension, and ascites.
- Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension, appears to play a central role in the hemodynamic changes and the decline in renal function in hepatorenal syndrome.
- Hepatorenal syndrome is characterized by a generally benign urine sediment, a very low rate of sodium excretion, and a progressive rise in the plasma creatinine concentration.
Management
- The ideal therapy for hepatorenal syndrome is improvement of liver function
- In ICU
- norepinephrine in combination with albumin
- Not in ICU
- Terlipressin in combination with albumin rather than midodrine octreotide and albumin
- Second line - TIPSS