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2014, Number 2

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Rev Med MD 2014; 5.6 (2)

Hepatorenal syndrome

Varela-Jiménez RE , Jiménez-Vega AR , Carrillo-Pérez DL , Carrillo-Maravilla E , Rodríguez-Ramírez S

Language: Spanish
References: 46
Page: 134-140
PDF size: 175.11 Kb.


ABSTRACT

Hepatorenal syndrome is a form of pre-renal acute kidney injury that shows no response to volume expansion. It occurs in patients with advanced liver cirrhosis or acute liver failure, and despite having a low incidence it has a high mortality. Its diagnosis is of exclusion and shares clinical characteristics with other causes of acute kidney injury in patients with liver cirrhosis, making it particularly difficult to diagnose and treat early. Spontaneous bacterial peritonitis is the main triggering factor and must be discarded in every patient with cirrhosis and kidney function deterioration. Prevention is the best manner of treatment. Primary antibiotic prophylaxis should be used in patients with a high risk of spontaneous bacterial peritonitis, as well as albumin in large volume paracentesis and rationalized use of diuretics and nephrotoxins. The use of beta-blockers should be suspended after the first episode of spontaneous bacterial peritonitis. Orthotopic liver transplantation is the treatment of choice and should be considered in every patient with hepatorenal syndrome. In non-candidate patients for orthotopic liver transplantation, renal replacement therapy has no improvement in prognosis. Simultaneous liver-kidney transplantation is indicated for patients in pre-transplant dialysis therapy higher than 8 weeks.


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