Features of the course of hepatorenal syndrome in decompensated portal hypertension (case report)

Abstract

Hepatorenal syndrome is a critical and potentially life-threatening complication in patients with advanced liver cirrhosis, characterized by the development of renal dysfunction in the absence of underlying structural kidney disease. Despite some encouraging studies of pharmacological treatments, the development of hepatorenal syndrome in people with cirrhosis implies a poor prognosis, as renal failure is usually irreversible unless a liver transplantation is performed. The purpose is to show the peculiarities of hepatorenal syndrome and the method of its successful treatment. The article describes a clinical case of hepatorenal syndrome in the postoperative period in a 54-year-old woman who was hospitalized urgently with bleeding esophageal varices. She has a history of liver cirrhosis associated with HCV and portal vein thrombosis, portal hypertension syndrome, blee­ding esophageal varices, ascites. After stabilization of hemodynamic parameters, the patient underwent a portoazygous disconnection, which included devascularization of the distal esophagus, proximal stomach, and esophageal transection. The first day of the postoperative period was complicated by the development of hepatorenal syndrome. Only its timely diagnosis in decompensated portal hypertension, with the elimination of pathophysiological components of the pathological process, allows correcting this complex pathology. When draining ascites, detoxification of the body is possible, which makes it possible to partially compensate for impaired kidney function. Albumin replacement therapy helps maintain osmotic balance.

Keywords

• hepatorenal syndrome
• liver cirrhosis
• portal hypertension
• ascites
• albumin