Kidneys in liver cirrhosis – Hepatorenal Syndrome

 




Kidneys in liver cirrhosis – Hepatorenal Syndrome

What are different complications of cirrhosis?

Liver Cirrhosis progresses to develop many complications.  It is prudent to be aware of the complications of liver cirrhosis, so that it can be picked up early and treated timely. Some of these are often ignored for long time before they become life threatening. The table shows different complications of liver cirrhosis.

Blood VomitusSwelling of feetPoor memory
Black StoolsFluid in chestAltered behaviour (Brain Involvement)
Blood in stoolsAscites – Fluid in abdomenHypoxia (Lung Involvement)
Nasal BleedingJaundiceLow BP (Heart Involvement)
Increased bleeding tendencyLoss of muscle massLow Urine (kidney Involvement)
Darkening of skinBone weakness (Osteoporosis)Loss of sexual hair (Gonad involvement)

 

Usually, the initial complications are fluid collection and bleeding. Renal involvement is a sign of very advanced disease. Kidney involvement presents as hepatorenal syndrome (HRS) or acute kidney injury (AKI).

 What is Hepato-Renal Syndrome? How common is it?

In hepatorenal syndrome (HRS) there is impaired renal function which is often precipitated by events lowering blood pressure.  it is estimated that 35-40% of patients with end-stage liver disease and ascites eventually develop HRS.

 What are the causes of HRS?

Any sudden change in fluid status of a person can precipitate HRS. Those who develop diarrhoea or vomiting can lead to fluid loss and decrease blood flow to kidney causing HRS. One of the very common reason we see HRS is overzealous treatment of ascites and edema. As ascites and edema are cosmetically and physically hindering, people and treating doctors tend to overuse water tablets (Diuretics) to mobilize this extra fluid stressing the kidneys. Any infection in the body can cause decrease in blood flow to the kidneys thereby causing low urine output and HRS

 What are the manifestations of HRS?

Individuals with hepatorenal syndrome will have a variety of nonspecific symptoms including fatigue, abdominal pain, and a general feeling of ill health (malaise). The most common symptom is sudden decrease in urine output. All individuals with cirrhosis should monitor their urine and should contact their hepatologist/liver specialist urgently once urine output decreases suddenly. Affected individuals also have symptoms related to advanced liver disease including the accumulation of fluid in the abdomen (ascites), yellowing of the skin and the whites of the eyes (jaundice), an enlarged spleen (splenomegaly) and an enlarged, extremely tender liver (hepatomegaly).

How do Identify HRS or Acute kidney injury?

It is usually identified with clinical decision making and help of certain blood and urine tests which are routinely carried out in all laboratories. Even mild rise in creatinine of 0.3mg should be alarming enough to inform your treating liver specialist. Your doctor may ask to test for any infection. There are certain blood tests which are upcoming which can be utilised to diagnose HRS.

How do you treat HRS?

HRS usually warrants admission. The doctor would start albumin and specialised medicines to improve blood pressure – midodrine, nor adrenaline, terlipressin. They would monitor creatinine, blood pressure and urine output. If infection is present, antibiotic is added. Most importantly the drugs which can affect kidneys are stopped urgently – painkillers, water tablets (diuretics) and Blood pressure lowering medicines. Propranolol and carvedilol if on should be stopped

How can we prevent it?

Avoiding dehydration and avoiding non monitored use of diuretics should be stressed upon any infection should be treated promptly.

 What does HRS mean to you as a patient?

Once HRS episode occurs, it is a sign that an urgent transplant evaluation is warranted. It classifies as stage 6 cirrhosis and needs to be evaluated for transplant. Anybody with one episode of renal dysfunction should be on the list for transplant as it indicates poor reserve by the body to cope of with liver disease and unless there is transplant soon, more than 50 percent are unlikely to survive even for a couple of years.

If you have high creatinine or low urine output meet your liver specialist. Do not increase the dose of diuretics without regular weekly monitoring.

 

If you suffer from cirrhosis and have developed any of above, please contact your hepatologist.

Dr Pathik Parikh
Liver Specialist / hepatologist in Ahmedabad
Contact no.: +91 86521 19730

Website : www.drpathikparikh.com


Comments

Post a Comment

Popular posts from this blog

fibroscan for liver inflammation - overview

  FibroScan is a non-invasive medical procedure used to assess liver health by measuring liver stiffness and determining the degree of liver fibrosis. While it's not specifically designed to detect liver inflammation, it can provide valuable information about overall liver health. Liver inflammation, also known as hepatitis, can result from various causes such as viral infections (like hepatitis B or C), alcohol consumption, fatty liver disease, autoimmune disorders, and other factors. It's a crucial aspect of liver health assessment as chronic inflammation can lead to liver damage and fibrosis over time. Although FibroScan primarily evaluates liver stiffness and fibrosis, it indirectly reflects liver inflammation. Inflammation can contribute to liver fibrosis, which in turn affects liver stiffness. Therefore, higher levels of liver stiffness detected by FibroScan may suggest the presence of inflammation. However, FibroScan alone may not provide a complete picture of liver infl
Read more

Understanding Drug-induced Liver Injury (DILI): Symptoms, Causes, and Treatment

  "Understanding Drug-induced Liver Injury (DILI): Symptoms, Causes, and Treatment" is a clear and informative title that covers the essential aspects of DILI. Here's an outline of what each section might include: Symptoms of Drug-induced Liver Injury (DILI): Overview of common symptoms such as fatigue, jaundice (yellowing of the skin and eyes), abdominal pain, nausea, vomiting, and loss of appetite. Discussion on the variability of symptoms depending on the severity and type of liver injury caused by different drugs. Causes of Drug-induced Liver Injury (DILI): Explanation of how certain medications and drugs can lead to liver injury. Classification of DILI based on mechanisms, such as direct hepatotoxicity, idiosyncratic reactions, and immune-mediated responses. Risk Factors for Drug-induced Liver Injury (DILI) : Identification of factors that increase the likelihood of developing DILI, including specific drug characteristics, patient-related factors (e.g., age, genetics
Read more

Liver Disease

Image
Liver is a complex organ with more than 500 functions. Liver diseases are not just limited to alcohol. Over the last two decades, liver diseases besides alcohol have been considered as a cause for liver failure. The list below is just to name a few. Non-Alcoholic Fatty Liver Disease Alcoholic Fatty Liver disease Viral Hepatitis Metabolic liver disease Autoimmune hepatitis Drug induced liver injury Vascular liver disease Congenital liver disease Primary biliary cholangitis Primary sclerosing cholangitis Infectious liver disease Granulomatous liver disease Fatty Liver disease is the most common cause of liver disease in India and worldwide. Alcohol related liver disease is constant through these years while viral hepatitis thanks to good treatment availability is decreasing. These liver diseases can present as any of the following manner. Asymptomatic – Incidental finding on investigations Acute hepatitis with or without jaundice Acute Liver failure Chronic hepatitis Cirrhosis of liver A
Read more