PMID: 9176015May 1, 1997Paper

The hepatorenal syndrome

Clinical Science
K Moore

Abstract

1. The hepatorenal syndrome is the development of renal failure in patients with severe liver disease in the absence of any identifiable renal pathology. 2. Decreased glomerular filtration is caused by a reduction in both renal blood flow and the renal filtration fraction. These changes arise as a consequence of a fall in mean arterial pressure due to systemic vasodilatation, activation of the sympathetic nervous system causing renal vasoconstriction, and increased synthesis of several vasoactive mediators, which together modulate both renal blood flow and the glomerular capillary ultrafiltration coefficient, and thence filtration fraction. 3. Patients with liver disease developing renal failure should have hypovolaemia excluded by volume challenge, and all nephrotoxic drugs including diuretics should be stopped. Broad-spectrum antibiotics should be given for subclinical infection, which may be a treatable precipitant of renal failure in cirrhosis. Renal perfusion should be optimized by ensuring that the blood pressure and systemic haemodynamics are adequate, and that if renal venous pressure is elevated, due to tense ascites, it is alleviated. 4. The prognosis of hepatorenal syndrome is poor with a > 90% mortality. However, pa...Continue Reading

Citations

Oct 27, 1999·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·D RichardsonA M Davison
Nov 30, 2000·Current Treatment Options in Gastroenterology·R PlanasJ Rodés
Sep 15, 2012·Clinical Journal of the American Society of Nephrology : CJASN·Andrew Davenport
Jul 18, 2002·Journal of Gastroenterology and Hepatology·Richard Moreau
May 17, 2007·São Paulo Medical Journal = Revista Paulista De Medicina·Tércio Genzini, Fábio César Miranda Torricelli
Jan 24, 2003·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Richard Moreau, Didier Lebrec
May 29, 1999·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·P AngeliA Gatta
May 3, 2000·Alimentary Pharmacology & Therapeutics·L DagherA Burroughs
Feb 24, 2006·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Richard Moreau, Didier Lebrec
Sep 1, 2004·Alimentary Pharmacology & Therapeutics·R Moreau, D Lebrec
Aug 29, 1998·Journal of Hepatology·J H HenriksenN J Christensen
Feb 28, 2002·Journal of Hepatology·Juan UrizJuan Rodés
Aug 14, 1999·Journal of the American Society of Nephrology : JASN·P Ginès, V Arroyo
Nov 25, 2003·Prostaglandins & Other Lipid Mediators·Indra Neil Guha, Kevin Moore
Mar 10, 2001·Clinics in Liver Disease·R BatallerJ Rodés
Jan 16, 2007·Best Practice & Research. Clinical Gastroenterology·Richard Moreau, Didier Lebrec

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