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| {{SK}} Heyd syndrome; HRS. | | {{SK}} Heyd syndrome; HRS. |
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| ==Overview==
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| '''Hepatorenal syndrome''' (HRS) refers to [[acute renal failure]] that occurs in the setting of [[cirrhosis]] or [[fulminant]] [[liver failure]] associated with [[portal hypertension]], usually in the absence of other disease of the [[kidney]] . It is a direct result of changes in the [[splanchnic]] and systemic circulation from [[cirrhosis]] or [[fulminant hepatic failure]]. It is usually secondary to trigger events which cause multi-system organ failure.
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| ==Historical Perspective== | | ==[[Hepatorenal syndrome overview|Overview]]== |
| Historically, the hepatorenal syndrome was first defined as [[Acute kidney injury|acute renal failure]] that occurred in the setting of [[Bile duct|biliary surgery]]. The syndrome was soon associated with advanced [[Liver diseases|liver disease]]. It was determined that kidneys [[Organ transplant|transplanted]] from patients with hepatorenal syndrome were functional, leading to the hypothesis that hepatorenal syndrome was a systemic process as opposed to renal disease, which affects the renal function.
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| ==Classification== | | ==[[Hepatorenal syndrome historical perspective|Historical Perspective]]== |
| The classification of hepatorenal syndrome is based on the deteriorating function of [[kidney]].
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| ==Pathophysiology== | | ==[[Hepatorenal syndrome pathophysiology|Pathophysiology]]== |
| The major pathophysiologic mechanism responsible for the clinical manifestation of [[hepatorenal syndrome]] is renal [[vasoconstriction]]. The hemodynamic disturbances include increased [[cardiac output]], systemic [[vasodilatation]] and low arterial [[blood pressure]]. Thus, renal vasoconstriction occurs even with a normal [[blood volume]] and increased [[cardiac output]].
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| ==Causes== | | ==[[Hepatorenal syndrome causes|Causes]]== |
| The cause of Hepatorenal syndrome (HS) is deteriorating function of [[liver]].
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| ==Differentiating Hepatorenal syndrome from other Diseases== | | ==[[Hepatorenal syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
| Many other diseases of the [[kidney]] are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome.
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| ==Epidemiology and Demographics== | | ==[[Hepatorenal syndrome risk factors|Risk Factors]]== |
| Hepatorenal syndrome (HRS) is common in cirrhotic patients.
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| ==Risk Factors== | | ==[[Hepatorenal syndrome screening|Screening]]== |
| Hepatorenal syndrome (HRS) develops on the background of advanced [[Liver diseases|liver disease]]. HRS may occur spontaneously mostly in type 2 HRS and may be precipitated in >70% of cases of type 1 HRS. | |
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| ==Screening== | | ==[[Hepatorenal syndrome differential diagnosis|Differentiating Hepatorenal syndrome from other Diseases]]== |
| There are predictors for patients suffering from [[liver]] disease to view chances of development of hepatorenal syndrome (HRS).
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| ==Natural History, Complications and Prognosis== | | ==[[Hepatorenal syndrome natural history|Natural History, Complications and Prognosis]]== |
| Hepatorenal syndrome progresses from pre-ascitic stage to frank ascites. [[Multiorgan system failure]], [[infections]] and [[chronic renal failure]] are the most common complication of HPS. Type I HPS carries poorer prognosis compared to type II HPS.
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| ==Diagnosis== | | ==Diagnosis== |
| There is no specific marker or imaging test to diagnose patients with hepatorenal syndrome (HRS). For that reason the diagnosis of HRS is based on criteria for excluding other causes of [[Renal insufficiency|renal impairment]] which are seen along with [[cirrhosis]].
| | [[Hepatorenal syndrome history and symptoms|History and Symptoms]] | [[Hepatorenal syndrome physical examination|Physical Examination]] | [[Hepatorenal syndrome laboratory tests|Laboratory Findings]] |
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| [[Hepatorenal syndrome history and symptoms|History and Symptoms]] | [[Hepatorenal syndrome physical examination |Physical Examination]] | [[Hepatorenal syndrome laboratory findings|Laboratory Findings]] | [[Hepatorenal syndrome electrocardiogram|Electrocardiogram]] | [[Hepatorenal syndrome chest x ray|Chest X Ray]] | [[Hepatorenal syndrome CT|CT]] | [[Hepatorenal syndrome MRI|MRI]] | [[Hepatorenal syndrome ultrasound|Ultrasound]] | [[Hepatorenal syndrome other imaging findings|Other Imaging Findings]] | [[Hepatorenal syndrome other diagnostic studies|Other Diagnostic Studies]] | |
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| ==Treatment== | | ==Treatment== |
| HRS may develop in two clinical types as an acute and rapidly progressive [[Renal insufficiency|renal failure]] ([[Acute kidney injury|AKI]]-HRS) or as chronic and not progressive [[renal failure]] (CKD-HRS) which can be managed with medications but the end treatment depends on [[Liver transplantation|liver transplant]].
| | [[Hepatorenal syndrome medical therapy|Medical Therapy]] | [[Hepatorenal syndrome primary prevention|Prevention]] | [[Hepatorenal syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatorenal syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| [[Hepatorenal syndrome medical therapy|Medical Therapy]] | [[Hepatorenal syndrome surgery|Surgery]] | [[Hepatorenal syndrome primary prevention|Primary Prevention]] | [[Hepatorenal syndrome secondary prevention|Secondary Prevention]] | [[Hepatorenal syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatorenal syndrome future or investigational therapies|Future or Investigational Therapies]]
| | ==Related Chapters== |
| | [[Cirrhosis]] |
| | [[Acute Liver Failure]] |
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| ==Case Studies==
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| [[Hepatorenal syndrome case study one|Case #1]]
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