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Diagnosis and Treatment of Hepatorenal Syndrome


2012-10-15 16:26

Hepatorenal Syndrome is a medical condition in which the complications of kidney insufficiency, renal circulation vasoconstriction and systemic haemodynamics occurs in the advanced cirrhosis patients. In other words, Hepatorenal Syndrome is a serious complication of severe liver disease, which commonly appears in 5various cirrhosis and other liver diseases, such as alcoholic cirrhosis, Fulminant hepatic failure, liver cancer and so on.

As for the pathogenesis, it is not completely known yet. Some researchers think that the disease may result from extreme underfilling of the arterial circulation secondary to an arterial vasodilation.

Diagnosis

The American Association for the Study of Liver Disease publics the diagnosis standard of hepatorenal syndrome. And the standards including 6 rules:

1. Cirrhosis complicated with Ascites

2. Serum Creatinine level>133μmol/L(15mg/L)

3. Serum Creatinine levels (≦133μmol/L, the recommended albumin dosage is about 1g/kg/d)have no change after albumin dilatation on the condition that the diuretics have been stopped for 2d.

4. Shock should be excluded.

5. The patient does’t receive toxic-kidney drugs or vascular-expanding treatment currently or recently.

6. The renal parenchymal disease should be excluded. If protein in urine >500mg/d and the red blood cells >50 under microscope, it may be renal parenchymal disease.

Treatment

Various treatments are available for hepatorenal syndrome. Severe liver disease is the basis of the disease, thereby treatment should improve liver function firstly. And meantime, the treatment should deal with the complications of liver disease and handle with the Kidney Failure.

1. Avoid the trigger of renal failure. Over drainage of ascites and overuse of diuretics should be avoided. Besides, the toxic-kidney drugs, such as gentamicin, neomycin and Non sterols anti-inflammatory drugs may also be the triggers. In addition, patients are suggested to pay attention to alimentary tract hemorrhage, inflammation, low blood pressure, hypovolemia and electrolyte disturbance etc.

2. Supplementary Treatment. Patients are suggested to take low protein and high sugar diet. The treatments for complications, such as alimentary tract hemorrhage, hepatic coma, are necessary.

3. Major treatments. The main treatments for hepatorenal syndrome include dilatation, diuresis, vasodilator substances, blood purification, surgery, liver transplant etc.



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