Hepatorenal syndrome differential diagnosis: Difference between revisions

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__NOTOC__
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{{Hepatorenal syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hepatorenal_syndrome]]
{{CMG}}; {{AE}}{{SKA}}


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==Overview==
Many other diseases of the [[kidney]] are associated with [[liver]] disease and must be excluded before making a diagnosis of hepatorenal syndrome. 
 
==Differentiating Hepatorenal Syndrome from other Diseases==
Many other diseases of the [[kidney]] are associated with [[Liver diseases|liver disease]] and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:<ref name="pmid17389705">{{cite journal |vauthors=Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V |title=Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis |journal=Gut |volume=56 |issue=9 |pages=1310–8 |year=2007 |pmid=17389705 |pmc=1954971 |doi=10.1136/gut.2006.107789 |url=}}</ref><ref name="pmid20682324">{{cite journal |vauthors=Martín-Llahí M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P |title=Prognostic importance of the cause of renal failure in patients with cirrhosis |journal=Gastroenterology |volume=140 |issue=2 |pages=488–496.e4 |year=2011 |pmid=20682324 |doi=10.1053/j.gastro.2010.07.043 |url=}}</ref><ref name="pmid22562534">{{cite journal |vauthors=Verna EC, Brown RS, Farrand E, Pichardo EM, Forster CS, Sola-Del Valle DA, Adkins SH, Sise ME, Oliver JA, Radhakrishnan J, Barasch JM, Nickolas TL |title=Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis |journal=Dig. Dis. Sci. |volume=57 |issue=9 |pages=2362–70 |year=2012 |pmid=22562534 |pmc=3979299 |doi=10.1007/s10620-012-2180-x |url=}}</ref><ref name="pmid19776409">{{cite journal |vauthors=Ginès P, Schrier RW |title=Renal failure in cirrhosis |journal=N. Engl. J. Med. |volume=361 |issue=13 |pages=1279–90 |year=2009 |pmid=19776409 |doi=10.1056/NEJMra0809139 |url=}}</ref><ref name="pmid8550036">{{cite journal |vauthors=Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J |title=Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club |journal=Hepatology |volume=23 |issue=1 |pages=164–76 |year=1996 |pmid=8550036 |doi=10.1002/hep.510230122 |url=}}</ref>
{| class="wikitable"
!Variables
![[Kidney]] injury associated with infection
!Prerenal [[Acute kidney injury|acute kidney injur]]<nowiki/>y
!Hepatorenal syndrome
!Parenchymal renal disease
|-
|Mechanism
Causes
|[[Infection|Infections]], including SBP
|Hypovolumia due:
gastrointestinal fluid losses
 
bleeding
 
diuretic
 
[[non-steroidal anti-inflammatory drug]]
|Splanic vasodalation due to nitic oxide
|[[Aminoglycoside]] therapy
[[Radiocontrast|Radiocontrast agent]]
 
Sepsis
|-
|Diagnostic clue
|History of fever
[[Blood culture|Blood cultures]]
 
Ascetic cultures
|History of:
Bleeding
 
Low [[blood pressure]]
 
Intake of [[Non-steroidal anti-inflammatory drug|NSAID]]
|Diagnosis of exclusion:
Liver failure + Renal failure
 
no apparent cause for the acute kidney injury
 
No improvement on removing
 
nephrotoxic agent


{{CMG}}
repleating fluid loss
|History of:
[[Infection|Infections]]


==Overview==
Injection of [[Dye]]


==Differentiating Hepatorenal Syndrome from other Diseases==
intake of nephrotoxic agent
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome.  They include the following:
|-
*[[Renal failure|Pre-renal failure]]:  Pre-renal failure usually responds to treatment with intravenous fluids, resulting in reduction in serum [[creatinine]] and the excretion of sodium.<ref name=IAC/>
|Prognosis
*[[Acute tubular necrosis]] (ATN): This can be difficult to confidently diagnose.  It may be an inability to concentrate the urine, if any is being produced. The urine sediment should be bland, microscopy may show [[hyaline cast]]s. ATN may recover with supportive treatment only or progress to [[end-stage renal failure]]. In cirrhosis, urinary sodium is not a reliable guide to the development of ATN, as [[fractional sodium excretion]] may stay below 1 percent, due to the gradual worsening of renal [[ischaemia]].
|Good
*Other causes may include [[glomerulonephritis|glomerular disease]] secondary to [[Hepatitis B]] or [[Hepatitis C]],<ref>Han SH.  Extrahepatic manifestations of chronic hepatitis B.  ''Clin Liver Dis.'' 2004 May;8(2):403-18.  PMID 15481347</ref> drug toxicity (notably [[gentamicin]]) or [[Radiocontrast|contrast nephropathy]].
|Good
|Poor
|Good
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
 
[[Category:Organ failure]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Nephrology]]
[[Category:Nephrology]]

Latest revision as of 21:55, 8 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. 

Differentiating Hepatorenal Syndrome from other Diseases

Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:[1][2][3][4][5]

Variables Kidney injury associated with infection Prerenal acute kidney injury Hepatorenal syndrome Parenchymal renal disease
Mechanism

Causes

Infections, including SBP Hypovolumia due:

gastrointestinal fluid losses

bleeding

diuretic

non-steroidal anti-inflammatory drug

Splanic vasodalation due to nitic oxide Aminoglycoside therapy

Radiocontrast agent

Sepsis

Diagnostic clue History of fever

Blood cultures

Ascetic cultures

History of:

Bleeding

Low blood pressure

Intake of NSAID

Diagnosis of exclusion:

Liver failure + Renal failure

no apparent cause for the acute kidney injury

No improvement on removing

nephrotoxic agent

repleating fluid loss

History of:

Infections

Injection of Dye

intake of nephrotoxic agent

Prognosis Good Good Poor Good

References

  1. ↑ Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V (2007). "Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis". Gut. 56 (9): 1310–8. doi:10.1136/gut.2006.107789. PMC 1954971. PMID 17389705.
  2. ↑ Martín-Llahí M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P (2011). "Prognostic importance of the cause of renal failure in patients with cirrhosis". Gastroenterology. 140 (2): 488–496.e4. doi:10.1053/j.gastro.2010.07.043. PMID 20682324.
  3. ↑ Verna EC, Brown RS, Farrand E, Pichardo EM, Forster CS, Sola-Del Valle DA, Adkins SH, Sise ME, Oliver JA, Radhakrishnan J, Barasch JM, Nickolas TL (2012). "Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis". Dig. Dis. Sci. 57 (9): 2362–70. doi:10.1007/s10620-012-2180-x. PMC 3979299. PMID 22562534.
  4. ↑ Ginès P, Schrier RW (2009). "Renal failure in cirrhosis". N. Engl. J. Med. 361 (13): 1279–90. doi:10.1056/NEJMra0809139. PMID 19776409.
  5. ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.

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