Liver: Hepatorenal Syndrome

Definition

• Definition: Acute Kidney Injury from Liver Failure
• May Be Insidious or Triggered by Paracentesis, Infection or GI Bleed

Pathophysiology

• Portal Hypertension Induces Splanchnic Arterial Vasodilation
• Progressive Increase in Cardiac Output & Decrease in Systemic Vascular Resistance
• Poor Renal Perfusion Causes AKI
  • Local RAAS Activation Causes Intense Renal Vasoconstriction
  • Urine: Low Na & High Osmolarity

Types

• Type I: Rapid Deterioration
  • Cr ≥ 2.5
  • Cr Increase ≥ Double
  • Timing < 2 Weeks
• Type II: Overall Stable & Less Severe

Treatment

• Primary Treatment: Vasoconstriction & Albumin
  • Vasoconstrictors: Norepinephrine, Vasopressin or Telipressin (Vasopressin Analog)
    • If Not Available: Midodrine & Octreotide
• If Fails: TIPS or Dialysis
• Last Resort: Liver TXP