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Hepatic
Nephropathy
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- Hepatorenal is a term used to
describe a collection of symptoms that arise when there is
failure of both liver and kidney.
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- When liver failure occurs there is a reduction of blood
flow (see risk factors) to the kidneys, which causes them to
shut down. Once the kidneys fail, toxic wastes build
up and a variety of symptoms develop.
- Conditions that can cause liver damage and failure are
as follows: cirrhosis (including alcoholic hepatitis, viral hepatitis, Wilson's disease, hemochromatosis,
schistosomiasis, etc.), liver cancer, toxins, and chemicals
such as carbon tetrachloride.
- Amyloidosis (caused by amyloid
infiltration of the liver and kidneys) is a
rare cause of this
syndrome.
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- Jaundiced yellow skin and the yellowish discoloration of the white part of the eyes
- Low urine volume
- Dark colored urine
- Tense abdominal swelling
- Nausea
- Vomiting blood or having bloody stools
- Confusion with or without hallucinations
- Shortness of breath
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- Clinical examinations may show signs of cirrhosis (ascites, spider veins, splenomegaly, jaundice etc).
- Hypotension
- Urine is low in volume, with a sodium concentration of less than 5mmol/L (which distinguishes from renal causes of kidney failure
- Blood tests may show increase in toxic waste normally excreted by the urine, evidence of liver failure (prolongation of prothrombin time, and elevation of bilirubin), hyponatremia (low sodium), and low albumin levels.
- Stool may be positive for blood.
- Renal ultrasound will show the ascites (fluid build up in the abdomen) and normal kidneys.
- Renal duplex Doppler, available in some medical facilities, may be helpful in identifying patients with cirrhosis who may be at risk for developing hepatorenal syndrome.
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- Sepsis
- Medications such as diuretics
- Gastrointestinal bleeding
- Malnutrition
- Excessive diarrhea and vomiting
- Abdominal paracentesis
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- Treatment of the liver disease will often reverse renal failure.
- Some patients with hypotension may benefit from intravenous albumin low in sodium.
- Intravenous dopamine may be given to some, but is often not effective.
- Removal of the fluid from the abdomen may relieve some of the symptoms, such as abdominal discomfort and shortness of breath.
- Liver transplant is the only curative treatment at this time.
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- Acute tubular necrosis
- Prerenal azotemia
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