Background and Objectives: The clinical profile of hepatorenal syndrome (HRS) patients admitted in a tertiary care hospital of Punjab was studied.
Methods: In this prospective study all the patients of chronic liver disease with renal involvement fulfilling the International Ascites Club criteria of HRS were evaluated over a period of one and a half year.
Result: Forty-two patients were diagnosed to have HRS and were included in the study. The incidence of HRS was 0.275%of hospitalmedical admissions. Alcoholic cirrhosis was the etiology in 71.5%of patients. Most of the patients of HRS received a combination of dopamine, albumin and terlipressin. Themortality ratewas found to be approximately 60%. Variables amongst survival versus non-survival groups were analyzed. Oliguria and hepatic encephalopathy weremore predominant in non-survival group. Serumbilirubin, hypoalbuminemia, hyponatremia, coagulopathy and urine osmolalitywas higher in non-survival group. Patients with Child-Pugh Score less than 10 had a better survival.
Conclusion: The poor prognostic factors in non-survival group were presence of ascites, severe jaundice, hepatic encephalopathy, alcohol abuse, hypoalbuminemia, progressive renal failure and a Child-Pugh Score > 10. Thus, HRS is not uncommon and needs proper diagnosis and prompt treatment to ensure better outcome.
Wilkinson SP, Blendis LM, Williams R. Frequency and type of renal and electrolyte disorders in fulminant hepatic failure. Br Med J1974;1:186-9.
Santiago JM. The hepatorenal syndrome. Med Clin North Am 2008;92(4):813-37.
Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome. Semin liver dis 2008;28(1):81-95.
Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy, clinical features, and outcome in a tertiary care centre. Am J Gastroenterol 2002;97(8):2046-50.
Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichaï P, et al. Terlipressin in patients with cirrhosis and type 1 HRS: A retrospective multicenter study. Gastroenterol 2002;122(4):923-30.
Butt AK, Khan AA, Alam A, Shah SW, Shafqat F, Naqvi AB. Predicting hospital mortality in cirrhotic patients: comparison of Child-Pugh and Acute Physiology, Age and Chronic Health Evaluation (APACHE III). Am J Gastroenterol 1998;93(12):2469-75.
Solerno F, Barroni G, Moser P, Badalamenti S, Cassarà L, Maggi A, et al. Survival and prognostic factors of cirrhotic patients with ascites; a study of 134 patients. Am J Gastroenterol 1993;88(4):514-9.
Epstein M, Berk DP, Hallenberg NK, Adams DF, Chalmers TC, Abrams HL, et al. Renal failure in the patients with cirrhosis; the role of active vasoconstriction. Am J Med 1970;49(2):175-85.
Porcel A, Diaz F, Rendon P, Macias M, Martin-Herrera L, Giron- Gonzalez JA. Dilutional hyponatremia in patients with cirrhosis and ascites. Arch Intern Med 2002;162(3):323-8.
Uriz J, Gines P, Cardenas A, Sort P, Jimenez W, Salmeron JM, et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol 2000;33(1):43-8.
Hadengue A, Gadano A, Moreau R, Giostra E, Durand F, Valla D, et al. Beneficial effects of the 2-day administration of terlipressin in patientswith cirrhosis and hepatorenal syndrome. J Hepatol 1998;29(4):565-70.
Colle I, Durand F, Pessione F, Rassiat E, Bernuau J, Barriere E, et al. Clinical course, predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with terlipressin: a retrospective analysis. J Gastroenterol Hepatol 2002;17(8):882-8. PDF created