Rare Medical Problems

Hepatorenal syndrome The hepatorenal syndrome refers to renal failure of unknown etiology that occurs in a fully hydrated patient with severe, often progressive, liver disease. Urine biochemistry is characteristic and renal histopathology unremarkable. The pathogenesis of the hepatorenal syndrome appears to involve intense intrarenal vasoconstriction and alteration in renal cortical blood flow, possibly due to an imbalance of prostaglandins and thromboxane. Early clinical experience suggested that only orthotopic liver transplantation was able to reverse the hepatorenal syndrome, although more recent evidence has reported up to 50 per cent survival in hepatorenal failure following paracetamol (acetaminophen) overdose. Renal failure is reversed after liver transplantation, suggesting that it is due to circulating or systemic factors. Excessive use of diuretics, sepsis, abdominal paracentesis, and gastrointestinal hemorrhage are all associated with an increased risk