What is hepatorenal syndrome? Manifestations of the disease

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Le Nguyen Hong Tram - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Nha Trang International General Hospital. The doctor has many years of experience in the examination and treatment of diseases of the digestive tract, especially gastrointestinal - hepatobiliary diseases, gastrointestinal endoscopy.
Acute decline in kidney function in people with acute liver disease or an exacerbation of end-stage liver disease is called hepatorenal syndrome (HCGT). The disease is mainly seen in patients with cirrhosis, ascites, portal hypertension, alcoholic hepatitis, or more rarely, liver tumors, fulminant hepatitis due to different causes.

1. Causes of hepatorenal syndrome

Common in patients with chronic liver cirrhosis. Hepatorenal syndrome in people with acute liver damage such as: alcoholic hepatitis; viral hepatitis; toxic hepatitis caused by drugs, toxic substances; liver damage due to shock (cardiogenic shock, septic shock, anaphylaxis, hypovolemic shock...) Predisposing factors include: infection with ascites; loss of fluid due to vomiting, diarrhea; hypoalbuminemia; increase circulating volume...

2. Signs and symptoms of hepatorenal syndrome

Typical symptoms of hepatorenal syndrome are acute liver disease or exacerbations on the background of chronic liver disease: fatigue, anorexia, gastrointestinal disturbances. Liver disease also causes a number of other recognizable symptoms such as yellowing of the skin and eyes, edema of the feet, weight gain, mental changes such as confusion, delirium, there may be systemic infection or ascites infection. , there may be bleeding on the skin due to coagulation disorders, angiosarcoma usually appears on the upper chest (angiosarcoma is a slightly raised hemangioma on the surface of the skin and has a small branch of blood vessels spreading around (like a spider's web). ), collateral circulation
Kidney failure also causes oliguria, dark urine, and fluid accumulation in the body.

3. Classification of hepatorenal syndrome

3.1 Type 1

This phase is characterized by rapidly progressive renal failure that, within 2 weeks, can double baseline serum creatinine to levels above 220 umol/l.
This phenomenon can occur spontaneously, but is usually followed by precipitating factors, especially infection with ascites, fluid loss, hypoalbuminemia...

3.2 Type 2

This stage is characterized by moderately progressive renal failure, often spontaneously. Creatinine concentration from 133-226 umol/l.
The survival prognosis of patients with type 2 is usually better than that of type 1 but shorter than in patients with cirrhosis without renal failure.

4. Measures to treat hepatorenal syndrome

4.1 Principles of treatment of hepatorenal syndrome type 1

Liver transplantation is one of the methods of radical treatment of hepatorenal syndrome. While waiting for liver transplantation, maintenance treatment is with albumin infusion and the use of vasopressors If the patient does not have severe liver failure and has failed treatment Vasoconstrictors may cause TIPS Do not use diuretics with hepatorenal syndrome type 1 Hemodialysis if acute pulmonary edema, severe hyperkalemia or metabolic acidosis unresponsive

4.2 Principles of treatment of hepatorenal syndrome type 2

Liver transplantation Treat ascites with diuretics when urinary sodium > 30 mEq/l Combine ascites drainage and albumin infusion in the presence of large ascites Fluid restriction in hyponatremia Vasopressors or TIPS may be considered When waiting for a liver transplant, Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of doctors, modern equipment and technology, but also stands out for its medical examination and treatment services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space.

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