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00:01 An important understanding of Hepatorenal Syndrome is required. 00:07 This is a functional renal failure without underlying renal pathology. 00:12 This is not nephralic syndrome, this is not nephrotic syndrome nor it is arteriosclerosis taking place at the renal artery. 00:19 The perfectly functional kidney, used to be the patient developed portal hypertension and now, there is a functional renal failure Is that clear? Very interesting. Important? Yes. 00:35 Type I: Severe with rapid renal failure. 00:40 your GFR drops, mortality almost 100% So, from now on, whenever you have portal hypertension, you can now go beyond, just cure hepatic portal hypertension, can't you? An important topic. 00:55 Type II: Insidious drop in GFR. 00:58 Diagnosis of exclusion. 00:59 Here, you'll find that urine sodium is less than 10mEq/L urine sodium is less than 10mEq/L It means to say, it is not able to properly take care of sodium handling. 01:08 There is no established therapy which makes it really dangerous. 01:12 And after transplantation of liver, it seems as though the kidney actually comes back to life. 01:18 Fascinating. We don't know a whole lot about it but we know just enough, where that statistic of 100% mortality puts it on the radar, big time.
About the Lecture
The lecture Hepatorenal Syndrome by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.
Included Quiz Questions
What is the treatment of choice for patients with hepatorenal syndrome?
- Liver transplantation
- Chemotherapy
- Steroids
- Antibiotics
- Antihypertensives
Which of the following factors determines the type of hepatorenal syndrome?
- Rapidity in the loss of renal function
- Amount of loss of renal function
- Severity of loss of renal function
- Severity of loss of hepatic function
- Rapidity of loss of hepatic function
Which of the following statements regarding hepatorenal syndrome is NOT true?
- Type 2 shows rapid loss of renal function.
- It includes type 1 and type 2.
- It is defined as functional renal failure without underlying renal pathology secondary to portal hypertension.
- Type 1 has a high mortality rate.
- It is usually a diagnosis of exclusion, with urine Na < 10 mEq/L.
Which of the following statements regarding hepatorenal syndrome is TRUE?
- Type 1 is defined as at least a 2-fold increase in serum creatinine to a level > 2.5 mg/dL in less than 2 weeks.
- Type 2 shows rapid loss of renal function.
- It is treated with steroids and antihypertensives.
- It is usually diagnosed with certainty based on the renal function only.
- It does not improve after liver transplantation.
A patient is diagnosed with hepatorenal syndrome. Which of the following laboratory abnormalities would be expected in this patient?
- Serum creatinine – increased Urine Na – decreased Serum transaminases – increased
- Serum creatinine – normal Urine Na – decreased Serum transaminases – increased
- Serum creatinine – increased Urine Na – decreased Serum transaminases – normal
- Serum creatinine – increased Urine Na – increased Serum transaminases – increased
- Serum creatinine – decreased Urine Na – decreased Serum transaminases – decreased
A 48-year-old man with cirrhosis is admitted to the hospital with spontaneous bacterial peritonitis. His lab values show: total bilirubin = 2.0 mg/dL, albumin level = 2.0 g/dL, creatinine = 1.2, and urine Na = 8 mEq/L on hospitalization. On day 6, the creatinine rises to 4.2, and the patient is anuric. What is the diagnosis of the patient?
- Type 1 hepatorenal syndrome
- Type 2 hepatorenal syndrome
- Hepatopulmonary syndrome
- Non-alcoholic liver disease
- Cirrhosis with portal hypertension
Author of lecture Hepatorenal Syndrome
Carlo Raj, MD
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