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What is Hepatorenal Syndrome?

Hepatorenal syndrome is a type of kidney failure that occurs as a complication of severe liver disease or cirrhosis. Its onset can be sudden or develop gradually as liver disease worsens. The condition itself may not cause physical symptoms, and it is usually only noticed when a patient is already in the hospital for liver problems. Emergency care in the form of medication, dialysis, and surgery is often necessary to prevent total kidney failure. Despite modern advancements in medicine and treatment techniques, hepatorenal syndrome and underlying liver problems are ultimately fatal for most patients.

Most people who experience hepatorenal syndrome have already been diagnosed with liver failure, hepatitis, or cirrhosis. Rarely, a severe infection, medications, or gastrointestinal disorders can also cause this type of renal failure. In addition to liver and kidney problems, a patient may experience abdominal inflammation, high blood pressure, and a condition called ascites, which is excess fluid in the abdominal cavity. The condition occurs when blood vessels in and around the kidneys become swollen and constricted, reducing the organ's ability to filter waste from the blood and produce urine.

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A person with hepatorenal syndrome may experience a decrease in urine flow, nausea, abdominal swelling, and mental confusion. Additional symptoms such as swelling in the extremities, jaundice, skin lesions, and reduced reflexes may also be present, but are more appropriately attributed to underlying liver problems. Immediate emergency care should be sought if a person experiences any symptoms of liver failure or hepatorenal syndrome to prevent a life-threatening situation.

Doctors usually conduct a series of imaging scans and blood tests to diagnose hepatorenal syndrome. The kidneys themselves usually appear normal in an ultrasound or computerized tomography scan, but the presence of ascites and inflammation can aid in a diagnosis. Blood samples are analyzed in a hospital laboratory to check for certain abnormalities. Laboratory doctors perform a glomerular filtration rate test, in which a sample is checked for unusually high levels of nitrogen and other waste compounds. Waste in the blood indicates the kidneys are not properly filtering the blood.

Treatment measures for hepatorenal syndrome and liver failure include intravenous medications to widen blood vessels and improve blood flow. A dialysis machine may be used to temporarily take over blood filtering for the damaged kidneys. A surgeon may decide to implant a shunt, a hollow tube that allows excess fluid to drain from the abdominal cavity. When possible, the most effective treatment procedure is a complete liver transplant. The kidneys tend to resume normal functioning following a successful liver transplant. Immediate expert treatment provides a patient with the best possible chances of surviving liver and kidney failure.

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