Liver and kidney syndrome

Liver and kidney syndrome's disease overview

Hepatorenal syndrome (HRS) is a condition of kidney failure in patients with chronic liver disease, progressive liver failure and increased portal vein pressure . This is a serious complication of cirrhosis and can be life -threatening

Kidney liver syndrome is divided into 2 types:

  • Type 1: Rapid renal failure is evaluated by the amount of creatinine in 2 weeks of the patient doubled compared to the original or higher than 221 µmol/l
  • Type 2: Adjusting renal failure (average serum creatinine about 178 µmol/l) is often combined with recurrent ascites or diuretic ascites

    • The prognosis of HRS Type 1 is very heavy and HSR Type 2 has a prognosis of patients shorter than pure cirrhosis but better than type 1

    Causes of Liver and kidney syndrome's disease

    The cause of liver and kidney syndrome has the following factors:

  • A ascites infection (is the cause of 20% of HSR Type 1 cases)
  • withdraw too many ascites without transmitting plasma (15% of HSR Type 1)
  • Major surgery

    • Gastrointestinal bleeding

  • Poison with kidneys such as anti -inflammatory analgesic, diuretic overdose

    • The mechanism of liver and kidney syndrome is divided into 5 stages corresponding to the kidney manifestations:

    Stage 1: Reduce sodium secretion in patients with cirrhosis still compensated

  • This is the first renal function abnormalities in cirrhosis patients and often appears before ascites
  • Patients with kidney perfusion, glomerular filtration level, normal free water balance but the ability to excrete sodium is discreetly reduced. The reason is due to the increase in portal vein pressure and low peripheral resistance

    • Stage 2: Keep sodium without activating the renin-ankiotensin-aldosterone system and sympathetic nervous system

    This is the progression of the disease when the patient cannot eliminate the amount of sodium into the body daily. Sodium stasis will retain water in the interstitial tissue and accumulate fluid in the abdominal cavity leading to ascites formation.

    Stage 3: Stimulating endogenous vasoconstriction system but kidney perfusion and glomerular filtration level are still preserved

  • When salt and water holding more will stimulate the increase in serum renin activity and increase the concentration of aldosterone and serum norepinephrine. Aldosterone increases the absorption of sodium in the distance and the donation while the sympathetic nerve activity in the kidney stimulates the reabsorption of sodium in the nearby tube, the Henle strap and the distance.
  • There may be circulatory dysfunction due to the increase in the activity of the sympathetic nervous system and the renin-angiotensin system
  • Although Angiotensin II, norepinephrine and anti -resistant hormones have a strong kidney effect, at this stage, kidney perfusion and glomerular filtration level are still normal. The reason is that these substances on the kidneys are minerated by the renal vasodilation system, especially prostaglandin. Farmure and glomerular filtration level in patients with cirrhosis depend mainly on prostaglandin, so the renal failure may appear at this stage if prostaglandin is inhibited by NSAIDs

    • Stage 4: The appearance of Type liver syndrome 2

  • This is the progression of cirrhosis when there is a severe circulatory decline. Patients with HRS Type 2 have Renin, Angiotensin, Norepinephrine and anti -serum resistant hormones in the serum very high, aortic blood pressure significantly decreases along with an increased heart rate

    • Causes are often due to the excessive activity of the endogenous circuit system, exceeding the renal vasodilation mechanism

    Stage 5: Progress of liver and kidney syndrome 1

  • Type 1 liver syndrome usually appears after a promotional factor such as severe infection, acute hepatitis on cirrhosis or patients undergoing a large surgery or hemorrhage digestion
  • The progress of HRS Type 1 related to rapid decline in system circulating function as well as a change in vasodilator mechanism at the kidney
  • The kidneys produce vasodilators that reduce endogenous vasodilators. But when there is a reduction in kidney perfusion, the synthesis of vasodilators may decrease
  • In short, HRS Type 1 was started with a sudden decline in circulatory function in the patient who had a decrease in the previous circulatory function but also offensed the necrosis. and renal anemia. Kidney necrosis increases the production of vasodilators in the kidneys and reduces the synthesis of vasodilators to form a pathology that makes the disease critical

    • Symptoms of Liver and kidney syndrome's disease

    Symptoms of liver and kidney syndrome include:

  • Fatigue, nausea, vomiting

    • Liver disease causes patients to show signs of jaundice, ascites, edema, weight gain and mental disorders (delirium, confusion)

    Spleen liver

  • muscle atrophy, trembling muscle, running
  • Star vascular signs on the chest

    • Renal failure causes urinary minimum, dark urine and fluid accumulation in the body

    People at risk for Liver and kidney syndrome's disease

    The subjects at high risk of liver and kidney syndrome are:

  • Patients with severe or previous liver failure
  • Patients with malnutrition
  • Patients with mild kidney failure previously
  • Patients with low blood sodium, increased potassium, decrease in blood glue or increased urinary osmotic pressure

    • esophageal varicose veins

    Prevention of Liver and kidney syndrome's disease

    To prevent liver syndrome in patients need:

  • Antibiotic and albumin transmission in patients with cirrhosis of ascites infection
  • Fostering volume in cases of loss of fluids such as diarrhea, gastrointestinal bleeding
  • Avoid using excessive diuretics causing epidemic loss

    • Do not use toxic drugs in the kidneys such as nsaids, aminoglycosides

    Diagnostic measures for Liver and kidney syndrome's disease

    Diagnostic criteria for liver and kidney syndrome according to International Ascites Club 2007 is:

  • Cirrhosis of ascites

    • Seruminine concentration> 133 mcmol/l (1.5 mg/dl)

  • Do not improve serum creatinine levels (down below 133 mcmol/l), after at least 2 days of treatment with diuretics and volume accommodation with albumin, Albumin recommend is 1g/kg of weight/day to maximum of 100g/day
  • There is no shock
  • Recently or currently do not use poison with kidneys
  • There is no kidney disease (proteinuria> 0.5g/day, microscopic hematoma (> 50 red blood cells per micro field) and/or abnormalities on ultrasound)

    • Liver and kidney syndrome's disease treatments

    Principles of treatment for liver syndrome Type 1:

  • The most thorough measure is liver transplant
  • While waiting for liver transplantation, the treatment is maintained by transmitting albumin and using vasoconstrictor drugs
  • If the patient does not have severe liver failure and fails to treat vasoconstrictor drugs, they can do tips
  • Do not use diuretics with liver syndrome Type 1

    • Hemodialysis if there is acute pulmonary edema, severe hyperkalemia or metabolic acidosis does not respond to treatment

    Principles of treatment for kidney syndrome Type 2:

  • Liver transplant

    • Restricting salt, only ascites treatment with diuretic when sodium> 30 meq/l

  • Combining to remove ascites and albumin transmission when large ascites
  • Restricting fluids in hypoglycatry blood
    • vasoconstrictor or tips can be considered when waiting for liver transplant

    Disclaimer

    Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

    The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

    Popular Keywords