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3.3.5 - Hepatorenal Syndrome and Hepatopulmonary Syndrome

from Section 3.3 - Acute Liver Failure

Published online by Cambridge University Press:  27 July 2023

By
Michael Spiro  and
Jeremy Fabes
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Hepatorenal syndrome (HRS) is the end result of progressive impairment of renal perfusion secondary to worsening hepatic failure.

  2. 2. HRS is a diagnosis of exclusion of acute kidney injury in chronic liver disease.

  3. 3. Both forms of HRS (types 1 and 2) have a poor prognosis, although HRS 1 typically leads to death within weeks.

  4. 4. Hepatopulmonary syndrome (HPS) develops from transpulmonary shunting, with resultant hypoxaemia.

Keywords

kidney injurykidney failureliver transplantationliver cirrhosishepatorenal syndromehepatopulmonary syndrome
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 171 - 173
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Grace, JA, Angus, PW. Hepatopulmonary syndrome: update on recent advances in pathophysiology, investigation, and treatment. J Gastroenterol Hepatol 2013;28:213–19.CrossRefGoogle ScholarPubMed
Krowka, MJ, Fallon, MB, Kawut, SM, et al. International Liver Transplant Society Practice Guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension. Transplantation 2016;100:1440–52.CrossRefGoogle ScholarPubMed
Salerno, F, Gerbes, A, Gines, P, Wong, F, Arroyo, V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007;56:1310–18.Google ScholarPubMed
Wong, F. The evolving concept of acute kidney injury in patients with cirrhosis. Nat Rev Gastroenterol Hepatol 2015;12:711–19.CrossRefGoogle ScholarPubMed

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