Hepatorenal Syndrome

Look for:

• Severe liver disease (cirrhosis)
• New-onset renal failure with no other explanation
• Very low urine sodium (< 10-15 mEq/dL)
• FeNa below 1%
• Elevated BUN:Cr ratio (greater than 20:1)

So, lab values are basically the same as prerenal azotemia.

Type 1 and Type 2

Type 1 is rapidly progressive; most die within 10 weeks without treatment

Type 2 is slower; survival of 3-6 months

most common causes of death are infection and hemorrhage

Tx

Liver transplant

if not possible,

Somatostatin (octreotide), midodrine (vasopressor)

consider Albumin (no clear benifit)