User:Mr. Ibrahem/Hepatorenal syndrome

Hepatorenal syndrome (HRS) is deteriorating kidney function in people with significant liver problems. Symptoms may include low urine output, tiredness, nausea, jaundice (yellowish skin), and confusion. Complications can include kidney failure.

Those affected usually have cirrhosis, though it may also occur in alcoholic hepatitis or liver failure. Additional risk factors include low blood pressure and low sodium. Onset may be triggered by infection, gastrointestinal bleeding, overuse of diuretics, draining ascites (fluid in the abdomen), surgery, or medications like ACE inhibitors. The underlying mechanism involves liver problems precipitating insufficient blood flow to the kidneys. The kidneys are otherwise normal. Diagnosis is based on laboratory tests of kidney function, after ruling out other possible causes. Type 1 includes a rapid decline in kidney function, while type 2 is associated with ascites that does not improve with diuretics.

Prevention involves avoiding medications that negatively effect the kidneys and giving albumin follow paracentesis or if spontaneous bacterial peritonitis occurs. Management involves increasing blood pressure, which may be achieved with intravenous fluids, terlipressin or norepinephrine, and albumin. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) or dialysis maybe other options. Outcomes are poor in type 1 disease, with death often occurring within two weeks, while in type 2 disease people may survive for 6 to 12 months without treatment. It is generally fatal unless a liver transplant is performed.

Hepatorenal syndrome affects about 4% of people with significant liver problems a year. In those with cirrhosis and ascites it occurs in about 20% within one year and 40% within five years. It was first identified in the late 1800s by Frerichs and Flint.