RT Book, Section
A1 Wong, Florence
A2 Lerma, Edgar V.
A2 Rosner, Mitchell H.
A2 Perazella, Mark A.
SR Print(0)
ID 1149112420
T1 Hepatorenal Syndrome
T2 CURRENT Diagnosis & Treatment: Nephrology & Hypertension, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259861055
LK accessmedicine.mhmedical.com/content.aspx?aid=1149112420
RD 2024/09/15
AB Renal  dysfunction  is  a  common  and  serious  problem  in  patients  with  advanced  liver  cirrhosis,  estimated  to  occur  in  20%  of  hospitalized  patients  with  cirrhosis,  and  even  more  commonly  at  54%  in  the  outpatient  setting.  Renal  dysfunction  in  cirrhosis  has  always  been  regarded  as  being  related  to  the  hemodynamic  changes  of  systemic  arterial  vasodilatation  and  paradoxical  renal  vasoconstriction  peculiar  to  cirrhosis  without  any  structural  changes  in  the  kidneys.  Such  cases  of  renal  dysfunction  are  known  as  functional  renal  failure  and  the  prototype  is  hepatorenal  syndrome  (HRS).  However,  it  is  now  recognized  that  many  liver  conditions  such  as  alcoholic  cirrhosis  or  hepatitis  C  can  cause  structural  renal  diseases,  and  yet  the  same  patients  can  also  develop  hemodynamic  abnormalities  as  cirrhosis  advances,  predisposing  them  to  functional  renal  failure.  Therefore,  the  demarcation  between  functional  and  structural  renal  diseases  is  no  longer  as  clear  as  once  thought.  Furthermore,  many  common  systemic  conditions  such  as  diabetes  can  cause  both  cirrhosis  and  nephropathy,  once  again  blurring  the  separation  between  structural  and  functional  renal  diseases.  Therefore,  the  concept  of  renal  dysfunction  in  cirrhosis  has  been  evolving,  and  that  also  includes  redefining  HRS,  especially  in  light  of  recent  changes  in  the  definition  of  acute  kidney  injury  (AKI)  by  the  nephrology  community.