Hepatorenal syndrome is a medical emergency that requires an immediate liver transplant or management with dialysis of the liver and kidneys until a new liver can be transplanted. This disease is a complication of cirrhosis of the liver. Cirrhosis is a state of death of the liver tissue in which liver tissue that was previously function turns into scar tissue after extensive damage. Despite the fame of the liver being the only organ in the body that can heal itself, damage of this kind is permanent. Hepatorenal syndrome gets its name from the two organs that are affected by it, namely the liver and the kidneys.
The exact course of the disease is quite complicated. With decreased liver function from cirrhosis, there is an increase in blood flow to the intestinal tract via the splanchinic circulation. When the vessels dilate for allowing increased blood flow, the renal circulation is then squeezed shut. This ends up damaging the kidneys and causing renal failure but not before the renin-angiotensin-aldesterone system tries to increase the blood pressure by secreting more renin and this consequently causes Aldesterone secretions to increase the retention of sodium. This makes things worse as the portal hypertension that is caused by an almost dead liver then increases. In a related condition, leakage from the portal vein causes fluid to build up in the peritoneum, causing a serious condition called ascites. Relieving this fluid buildup is even more complicated as an improper paracentesis can also cause hepatorenal syndrome if intravenous saline is not administered after the procedure.
Albumin is one of the main elements that is used to extend the life of person with the complication. This is because a liver dialysis uses albumin bound in a membrane to perform the detoxification of the blood taking the load off the liver. Unfortunately, all these procedures are not really effective for nearly 50% percent of those with Type 1 hepatorenal syndrome who eventually die of the condition sometimes irrespective of transplants. The prognosis is only slightly better for those with the Type 2 variant of the disease. There is a lot of benefit in the use of some of the drugs that constrict the circulation of the splanchic system like somatostatin analogues. This is one of the major problems that one needs to face if suffering from ascites, portal hypertension, and is something to look forward to if you are a heavy drinker.