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Hepatorenal syndrome (ASS) can be defined as the unexplained cause of renal failure that occurs in people with liver disease without clinically, laboratory, or anatomically identifiable reasons for renal dysfunction.
Most often, hepatorenal syndrome occurs in people with cirrhosis of the liver. It is also assumed that this syndrome may appear as a complication after surgery on the bile ducts, pancreas, obstructive jaundice, lymphocytic leukemia, and in advanced forms of gastrointestinal cancer in patients treated with chemotherapy or hyperthermia. This type of abnormality also occurs in children who have had a liver transplant.
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Unknown causes
So far, not all the causes of hepatorenal syndrome have been elucidated. It is known, however, that this syndrome is an example of an extreme imbalance between factors determining vasoconstriction and expansion. An important role in the pathogenesis of the disease is also played by the hormones circulating in the blood, which act as vasodilators. One of them is glucagon. There is also much talk about the role of endothelin and nitric oxide. It has also been recognized that prostaglandins play a role in the control of renal function in patients with advanced liver disease. The fact that the urine sediment is sparse and does not show pathological features also speaks for functional renal failure in IE. It is also known that the kidneys may return to normal on their own. In addition, kidneys taken from deceased people who have had IE return to normal work after transplantation.
Morphological changes in the kidneys of patients with IU are slight. In histopathological examinations using the traditional electron microscopy technique and the immunofluorescence technique, slight anatomical changes in the glomeruli, tubules, renal vessels or interstitial tissue are found.
Symptoms
Classic hepatorenal syndrome occurs in people with long-term cirrhosis, usually those who abuse alcohol. The hallmark is advanced ascites that is resistant to treatment.
Two clinical periods are distinguished in the course of the disease: the period before the nitrhermia and the azithothermic period (increased nitrogen content in the blood).
The kidney function deteriorates in the pre-nitherothermic period, i.e. in the pre-uraemic period. The pre-uremic period lasts a long time and often does not cause any alarming symptoms. It becomes visible when the azo -othermia occurs.
In the initial stage of the nitro-thermic period, which lasts 3-7 days, there is a mean increase in urea with normal creatinine clearance and various degrees of hyponatraemia. The patient is very weak, drowsy, has no appetite, and the muscles atrophy.
After a few days, nausea, vomiting and excessive thirst appear. All of this leads to the development of azothermia. Laboratory tests show, among others. increase in the concentration of urea in the blood serum. Complication of this condition may be massive upper gastrointestinal haemorrhages. However, the urine test shows only minor abnormalities. The final stage of the disease is manifested by deep coma, severe hypotension and reduced diuresis. The kidneys retain the ability to concentrate urine considerably. However, when a patient dies, renal failure is rarely recognized as the cause of the death.
Treatment
The main therapeutic goal is to improve liver function. Fluids and salt are restricted for the sick. It is necessary to constantly control the concentration of electrolytes in order to balance the water and electrolyte balance. During the treatment period, sedatives and barbiturates are not used. It is also necessary to protect the patient from infections. When hepatic coma occurs, medications to cleanse the body and neomycin are given to reduce the production of ammonia in the gastrointestinal tract. The diet should contain small amounts of protein. In the event of a haemorrhage, it must be controlled quickly.
With proper care and proper medical treatment, the liver can recover. Unfortunately, this happens less often than doctors and patients themselves expect. Hence, high mortality is reported in the event of hepatorenal syndrome. It is close to 100 percent. Life expectancy is estimated at 6 weeks from the time of the onset of azothermia. Death is usually the result of severe hepatic complications, especially hepatic encephalopathy and massive gastrointestinal haemorrhage.
Tekst: Anna Jarosz