Hepatorenal Syndrome

What is Hepatorenal Syndrome?

Hepatorenal syndrome is a condition that involves a progressive form of kidney disease, common process is kidney failure. This would persist and can provide a grave effect on the person’s life by complications. As described and known in the medical profession, the hallmark or pathognomonic sign for hepatorenal syndrome is renal vasoconstriction. This condition is found to be common in the United States. Statistical reports show that about 10% of cases who are suffering from cirrhosis and ascites has hepatorenal syndrome. It is believed that this condition is a result of uncompensated cirrhosis. In the world, the cases of hepatorenal syndrome are similarly increasing as just like in the United States. Those at risk for this condition are people with medical history of chronic liver disease or those who are suffering from liver disease. Men and women are equally affected with this syndrome. Increasing age is a factor for this condition. Those who are at their 4th to 8th decade of life are at most risk for acquiring hepatorenal syndrome.


Diagnosis

Diagnostic tests for this condition include the following:

  1. Physical assessment can help in the diagnosis of the condition. Identification of the probable signs of hepatorenal is done. These signs include mental confusion, ascites, skin discoloration, bruits, gynecomastia and lesions on the skin. Accumulated data such as the abrupt decrease or loss of urine output would indicate presence of the disease process.
  2. Blood tests – Tests such as those that can identify the levels of BUN and creatinine levels of the patient are necessary. A low serum sodium level or concentration is another sign of the disease. Changes in the prothrombin time of the patient would help suggest liver problems. The ammonia levels are significantly higher than the usual levels.

Symptoms

Hepatorenal syndrome is reported to have no specific signs or symptoms. It is however, common to patients who suffer from chronic liver diseases, such as cirrhosis. The following are the typical presentations of hepatorenal syndrome as basically influenced by cirrhosis:

  • Changes in the levels of consciousness or mental alertness. Patients tend to be confused, experience delirium and eventually dementia.
  • Palmar erythema (redness).
  • Asterixis or also known as liver flap, a tremor observed on the patient’s wrist when it is dorsiflexed (extended).
  • Muscle wasting and clubbing of hands
  • Fetor hepaticus – This is known as severe bad breath among patients with hepatorenal syndrome. It is widely referred as breath of the dead because of the smell an affected emits from their mouths can be compared to a dead corpse.
  • Gynecomastia – Men are most affected of the problem. There is an increase in the breast size or chest area of men.
  • Ascites – There is accumulation of fluid in the peritoneal cavity of the patient. It is a very common presentation of liver problems. This can also cause for an increase in one’s weight.
  • Peripheral edema
  • Bruits – A sound that is heard when one uses a stethoscope over the heart. Sometimes, the sound that it emits is confused with a heart murmur.
  • Caput medusa – This is characterized by the distention of the umbilical or abdominal veins. It may also be engorged in appearance.
  • Hernia
  • Loss of pubic hair
  • Dark colored urine – This indicates for kidney malfunction.
  • Jaundice -Yellow discoloration of the skin.

Possible complications include hemorrhage, organ/s failure, congestive heart disease leading to failure and secondary infections.

Causes

Hepatorenal syndrome is a condition that is basically caused by an underlying chronic liver problem. Those who are at risk of this condition are patients who suffer from liver cirrhosis. If there is a decrease in the normal functioning of the kidney, then it can also precipitate those who suffer from liver disease to develop hepatorenal syndrome. Others that are at risk of the condition are those who have alcohol hepatitis and liver failure.

Treatment

The most recommended treatment or intervention for hepatorenal syndrome is liver transplantation. As this is done, patients would readily attain a success from the treatment process provided for them. But other studies have shown that this can only be a limited intervention. Other surgical interventions are the following:

  • PVS or peritoneovenous shunting. This is done to improve one’s circulatory functioning.
  • Surgical shunting.
  • Medications that are unnecessary are halted, so to avoid placing harm in one’s kidneys. The taking of antibiotics, NSAIDS and diuretics are contraindicated in cases of hepatorenal syndrome. Vasopressin is indicated to improve one’s circulatory functioning. The sympathomimetic agents are prescribed I order to improve the patient’s renal artery perfusion. In order to avoid bleeding, plasma volume expanders are provided.
  • Renal replacement may be indicated. This is also known as renal dialysis.
  • Patients are provided with albumin and dopamine in order to improve the patient’s kidney function.
  • Prevention of complications. It is very important that one would comply with the treatment regimen provided by the doctor. Once a liver and kidney condition has been diagnosed, we can avoid the effects of hepatorenal syndrome if we comply and maintain a healthy lifestyle.

Prognosis

As reported in most or a number of cases with hepatorenal syndrome, the disease process can be very fatal and even cause death. Once a person is diagnosed with the condition, it is believed that the condition’s prognosis is poor. This is entirely because of its wide affectation and effect of the disease condition. Death is believed attained when the patient has acquired a secondary infection. Patients with hepatorenal syndrome are also immunocompromised, making them susceptible to other diseases. Another probable outcome from hepatorenal syndrome is hemorrhage, making this another cause of death among patients.

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