"Hepatorenal syndrome is a life-threatening condition characterized by rapidly Progressive kidney failure that is seen in people with Advanced liver disease the prognosis is very Bleak and is usually fatal without the transplant there are two types type 1 has a median survival of two weeks and features a rapidly increasing creatinine level type 1 happens commonly in taneous bacterial peritonitis type 2 is a slightly more moderate form with a median survival of 10 weeks and a steadier creatinine here patients typically have a site that is resistant to DirectX approximately 18% of cirrhotic patients who have ascites will develop hepatorenal syndrome within one year so what exactly that makes this condition so bad the Hallmark is a renal basic constriction in the setting of vasodilation in splanchnic breasts those are the intestines spleen liver and pancreas the main branches of the aorta that make it up at the Celiac artery as well as the superior and inferior mesenteric arteries the underfill theory is that as liver disease progresses and portal hypertension follows possibly also generating ascites there is a splash so dilation because of release of vasodilatory mediators like nitric oxide and prostaglandins this vasodilation leads to more blood being directed into the splanchnic vessels which ends up draining into the portal circulation which causes the juxtaglomerular apparatus of the kidney to activate the renin-angiotensin-aldosterone system leading to vasoconstriction and in particular in the kidneys but the splanchnic vasculature is resistant to vasoconstriction due to the production of local vasodilators like nitric oxide and so remains vasodilate it the cycle leading to this vicious cycle of the renal vasoconstriction and splanchnic vasodilation ultimately leading to renal failure the activation of the renin-angiotensin-aldosterone is thought to be an important step in the formation of ascites in patients with cirrhosis to the extent that ascites and hepatorenal syndrome may be considered a splanchnic vasodilation determined the resistance of ascites to diuretics as is seen in type 2 hepatorenal syndrome as well as the onset of kidney vasoconstriction that leads to the initial onset of hepatorenal syndrome it is important to remember that having a cirrhotic patient with an AK I does not mean that the patient has HRS they may have the Aki for other reasons and so hepatorenal..."
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