15. Renal Complications of Liver Disease and the Hepatorenal Syndrome

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Florence Wong MD, FRCPC

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch15

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Wong, F. (2011) Renal Complications of Liver Disease and the Hepatorenal Syndrome, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch15

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. University of Toronto, Staff Hepatologist, Toronto General Hospital, Toronto, ON, Canada

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

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Keywords:

  • Acute kidney failure;
  • ascites;
  • cirrhosis;
  • functional renal failure;
  • hepatorenal syndrome;
  • liver transplantation;
  • midodrine;
  • terlipressin;
  • vasoconstrictors;
  • vasodilatation

Summary

Functional renal failure is a common complication of advanced cirrhosis with ascites, to be distinguished from organic renal diseases that are now increasingly seen in patients with cirrhosis. The basis for the development of functional renal failure is systemic arterial vasodilatation with paradoxical renal vasoconstriction. Cardiac dysfunction and altered renal autoregulation also contribute to the pathogenesis. There are recent efforts to lower the cutoff value for diagnosing functional renal failure, so as to encourage early application of treatment. Clinical presentations can range from volume-responsive prerenal failure to potentially fatal hepatorenal syndrome. The mainstay of treatment includes the removal of precipitating factors, intravascular volume replacement, vasoconstrictor therapy, insertion of a transjugular intrahepatic portosystemic stent shunt, or liver transplantation. Liver transplantation remains the treatment of choice for hepatorenal syndrome as it corrects many of the pathophysiologic abnormalities associated with this condition. Patient outcome is improved further if renal function is normalized before liver transplantation.