Hepatorenal syndrome

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Male urinary system

Treatment aims to improve liver function and ensure that there is enough blood volume in the body and that the heart is pumping it adequately.

The disorder is generally treated in the same way as kidney failure from any other cause.

• All unnecessary medicines should be stopped, especially the antibiotic neomycin, ibuprofen and other NSAIDs, and diuretics ("water pills").
• Dialysis may improve symptoms.
• Medications such as octreotide plus midodrine, albumin, or dopamine may be used temporarily to improve kidney function.
• A nonsurgical shunt (known as TIPS) is used to relieve the symptoms of ascites and may help kidney function. Surgery to place a shunt (called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may also relieve some of the symptoms of kidney failure. Both procedures are risky and proper selection of patients is very important.

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The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.

• Bleeding
• Damage to, and failure of, many organ systems
• End-stage kidney disease
• Fluid overload with congestive heart failure or pulmonary edema
• Hepatic coma
• Secondary infections

This disorder most often is diagnosed in the hospital during treatment for a liver disorder.

Review Date: 05/04/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).