Hepatorenal syndrome differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
Overview
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome.
Differentiating Hepatorenal Syndrome from other Diseases
Differentiating Hepatorenal Syndrome from other Diseases
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:[1][2][3][4][5]
| Variables | Kidney injury associated with infection | Prerenal acute kidney injury | Hepatorenal syndrome | Parenchymal renal disease |
|---|---|---|---|---|
| Mechanism
Causes |
Infections, including SBP | Hypovolumia due:
gastrointestinal fluid losses bleeding diuretic |
Splanic vasodalation due to nitic oxide | Aminoglycoside therapy
Sepsis |
| Diagnostic clue | History of fever
Ascetic cultures |
History of:
Bleeding Low blood pressure Intake of NSAID |
Diagnosis of exclusion:
Liver failure + Renal failure no apparent cause for the acute kidney injury No improvement on removing nephrotoxic agent repleating fluid loss |
History of:
Injection of Dye intake of nephrotoxic agent |
| Prognosis | Good | Good | Poor | Good |
References
References
- ↑ Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V (2007). “Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis”. Gut. 56 (9): 1310–8. doi:10.1136/gut.2006.107789. PMC 1954971. PMID 17389705.
- ↑ Martín-Llahí M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P (2011). “Prognostic importance of the cause of renal failure in patients with cirrhosis”. Gastroenterology. 140 (2): 488–496.e4. doi:10.1053/j.gastro.2010.07.043. PMID 20682324.
- ↑ Verna EC, Brown RS, Farrand E, Pichardo EM, Forster CS, Sola-Del Valle DA, Adkins SH, Sise ME, Oliver JA, Radhakrishnan J, Barasch JM, Nickolas TL (2012). “Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis”. Dig. Dis. Sci. 57 (9): 2362–70. doi:10.1007/s10620-012-2180-x. PMC 3979299. PMID 22562534.
- ↑ Ginès P, Schrier RW (2009). “Renal failure in cirrhosis”. N. Engl. J. Med. 361 (13): 1279–90. doi:10.1056/NEJMra0809139. PMID 19776409.
- ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (1996). “Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club”. Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.
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