Hepatorenal syndrome

Introduction Hepatorenal syndrome (HRS) refers to functional acute renal failure (FARF) that occurs in severe liver disease, and the clinical progression is progressive. HRS is a specific acute renal failure associated with severe liver disease. Its greatest feature is that this acute renal failure is functional. It is generally believed that this FARF has no acute tubular necrosis or other obvious pathological aspects. Morphological abnormalities. Late liver cancer is often complicated by severe liver failure. Progressive, prerenal renal failure, renal histology may have no obvious or only mild non-specific changes, called liver and kidney syndrome, refers to the sudden emergence of unexplained oliguria in patients with advanced liver cancer without a history of kidney disease Nitrogenemia.

Cause

1. Increased renal sympathetic tone In severe liver cirrhosis or liver cancer, liver cells are extensively damaged, causing severe damage to liver function, ascites, dehydration, upper gastrointestinal bleeding and ascites can lead to effective circulating blood volume reduction, reflexivity Causes sympathy - excitability of the adrenal medulla system, contraction of human small arteries, increased synthesis and secretion of renin, elevated concentration of catecholamine in the blood, decreased glomerular filtration rate, induced functional renal function Depletion.

2, pseudo-neurotransmitter increased liver function, blood metabolites can not be eliminated, pseudo-neurotransmitters replaced normal peripheral sympathetic neurotransmitters, reducing peripheral vascular tone, causing small artery dilation, blood pressure, kidney blood Reduced perfusion, decreased glomerular filtration rate, leading to hepatorenal syndrome.

an examination

The clinical features of hepatorenal syndrome are two kinds of symptoms of liver decompensation and functional renal failure, which are more common in the terminal stage of liver cancer. Patients with severe cirrhosis, or extensive infiltration of liver cancer cells, have progressive oliguria and nausea after rupture of liver cancer, upper gastrointestinal bleeding, massive discharge of ascites, high-dose diuretics, severe infections, and surgery. , vomiting, apathy, even sleepiness, azotemia, low urinary sodium and other signs of renal failure, should be suspected of complicated liver and kidney syndrome, when the daily urine output <500ml, blood sodium <130mmol / L, urine sodium <7.5 Methyl / L, blood urea nitrogen and inosine increased, urine protein is positive, and can rule out the kidney itself, it can be diagnosed.

Differential diagnosis

1, simple pre-renal azotemia: there are pre-renal factors, such as severe hypotension, a large number of diuretic, ascites or blood loss, renal function can be quickly restored after experimental rehydration.

2, acute tubular necrosis:

(1) Urine sodium > 40 mmol / L.

(2) Urine/creatinine <10.

(3) The ratio of urine/blood osmotic pressure is <1.

(4) The urine specific gravity is low, <1.015.

(5) Urine routine has more protein, cell tube type and granular tube type.

3, pseudo-hepatic and renal syndrome: some serious diseases, such as toxic poisoning, severe sepsis or disseminated intravascular coagulation, can damage the liver and kidney at the same time causing the so-called "pseudo-hepatorenal syndrome", but it is not caused by severe liver disease Cause, identification is not difficult.

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