Hepatorenal syndrome pathophysiology: Difference between revisions
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[[Image:Hepatorenal_syndrome.jpg|thumb|300 px|center|Liver pathology is altered in HRS while kidney histology is normal. The image is a trichrome stain of cirrhosis of the liver, the most common cause of HRS.]] | [[Image:Hepatorenal_syndrome.jpg|thumb|300 px|center|Liver pathology is altered in HRS while kidney histology is normal. The image is a trichrome stain of cirrhosis of the liver, the most common cause of HRS.]] | ||
==References== | ==References== | ||
Revision as of 13:24, 28 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
The pathology involved in the development of hepatorenal syndrome is thought to be an alteration in blood flow and blood vessel tone in the circulation that supplies the intestines (the splanchnic circulation) and the circulation that supplies the kidney.[1] It is usually indicative of an end-stage of perfusion, or blood flow to the kidney, due to deteriorating liver function. Patients with hepatorenal syndrome are very ill, and, if untreated, the condition is usually fatal.
The renal failure in hepatorenal syndrome is believed to arise from abnormalities in blood vessel tone in the splanchnic circulation (which supplies the intestines).[2] It is known that there is an overall decreased systemic vascular resistance in hepatorenal syndrome, but that the measured femoral and renal fractions of cardiac output are respectively increased and reduced, suggesting that splanchnic vasodilation is implicated in the renal failure.[3]
There is activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, and profound vasoconstriction of the kidneys.[4] Many vasocontrictor chemicals have been hypothesized as being involved in this pathway, including vasopressin,[5] prostacyclin, thromboxane A2,[6], and endotoxin.[1]
Microscopic Pathology
References
- ↑ 1.0 1.1 Arroyo V, Guevara M, Gines P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2002 May;122(6):1658-76. PMID 12016430.
- ↑ Gines P, Arroyo V. Hepatorenal syndrome. J Am Soc Nephrol 1999 Aug;10(8):1833-9. PMID 10446954
- ↑ Fernandez-Seara J, Prieto J, Quiroga J, Zozaya JM, Cobos MA, Rodriguez-Eire JL, Garcia-Plaza A, Leal J. Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology 1989 Nov;97(5):1304-12. PMID 2676683
- ↑ Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993 Jul;105(1):229-36. PMID 8514039.
- ↑ Lenz K, Hortnagl H, Druml W, Reither H, Schmid R, Schneeweiss B, Laggner A, Grimm Gm Gerbes AL. Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis. Effects on renal hemodynamics and atrial natriuretic factor. Gastroenterology 1991 Oct;101(4):1060-7. PMID 1832407
- ↑ Moore K, Ward PS, Taylor GW, Williams R. Systemic and renal production of thromboxane A2 and prostacyclin in decompensated liver disease and hepatorenal syndrome. Gastroenterology 1991 Apr;100(4):1069-77. PMID 2001805