Hepatorenal syndrome

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Hepatorenal syndrome

Treatment is aimed at improving liver function and to ensuring that circulating blood volume and cardiac output (heart pumping action) are adequate. The disorder is generally treated in the same manner as kidney failure from any cause. All unnecessary drugs (particularly neomycin, NSAIDS and diuretics) are stopped. Dialysis may improve symptoms. There are medications such as octreotide, albumin, and dopamine, which may be used as a temporary measure to improve kidney function.

Surgical placement of a shunt from the abdominal space (peritoneum) to the jugular vein or superior vena cava (called a Levine shunt) may reduce ascites and reverse some of the symptoms of kidney failure. However, surgical shunts are rarely placed, because severe liver disease makes surgery very risky. A non-surgical transjugular intrahepatic portosystemic shunt (TIPS) may be tried in some patients.

The probable outcome is poor. Death commonly occurs as a result of secondary infections or hemorrhage.

• Secondary infections
• Bleeding
• Hepatic coma
• End-stage kidney disease
• Fluid overload with subsequent congestive heart failure or pulmonary edema
• Damage and failure of multiple organ systems

This disorder most often is diagnosed in the hospital during treatment for a liver disorder.

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