Hepatorenal syndrome

It is diagnosed when acute liver failure or chronic liver disease is already established but

Not simultaneously occurred.

Sepsis or bacteremia must be ruled out and no diretic has been given recently. There should

No recent use of nephrotoxic agent i.e ACE I, ARB, Nsaids, Aminoglycoside etc.

There are two types of HRS established for the sake for understaining and different prognostic

Value.  Typer 1 is manifested for rapidly rise of creatinine usally along with high billirubine and

Prothrombin time. Patients usually die in 2 weeks when left untreated. While in Type 2 there is

Gradual rise of serum creatinine especially in setting of Ascitis which is resistent  to diuretics.

Patients survive upto to 4 to 6 month in case of no treatement offered.

Orthotopic liver transplantion is the treatment of choice but before that paients must be offered

Vasoconstrictive therapy with albumin infusion.

Choice of vasoconstrive therapy are:  Octreotide 4 to 6 mg in TDS which can be increased to 12 mg per

Day. Along with albumin 1 to 1.5 mg per kg for days.

Others options are ocreotide, vasopressin , norepinephrine, midodrine.

Surgical option is TIPS . It is Transhepatic portosystemic shund, and it is an adjuvant.