Hepatorenal Syndrome - causes, pathophysiology and mechanism

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"Hepatorenal syndrome is one of many potential causes of acute kidney injury in patients with acute or chronic liver disease including liver cirrhosis, severe alcoholic hepatitis and fulminant liver failure. In liver injury portal venous pressure increases resulting in portal hypertension. When this happens the portal vein tries to help by dilating the blood vessels to reduce the portal venous pressure. It does so by releasing Nitric oxide (NO) from the endothelium.
NO causes vasodilation of the arteries in the splanchnic circulation which decreases total peripheral resistance or the systemic vascular resistance. As hepatic disease becomes more severe the splanchnic arterial vasodilation and reduced systemic vascular resistance leads to reduced effective circulatory volume. Reduced effective circulatory volume means less blood is actually getting to the kidneys resulting in kidney injury and activation of the renin angiotensin aldoesterone sytem
Bacterial peritonitis or acute gastrointestinal bleeding (as a result of hepatic failure and portal hyeprtension) can trigger hepatorenal syndrome. Hepatorenal syndrome manifests as acute renal injury with reduced urine sodium in the setting a precipitating event in someone with liver failure."
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[@rajeshmithun9455]

one of the best illustration of HRS

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[@OnceUponaTimeinIran-]

Excellent explanation! Thanks a ton!

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[@danielmoses2156]

THANKS

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[@celramj5998]

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[@tss0828]

Thank you!!!!!!

[@roseart7485]

2nd comment thank you for the video! I needed clarification on this

[@andyspark5192]

Hello. Could you make an update on CoViD? The is new data emerging about damage of the endothelial cells, followed by blood clots and increased oxidative stress. Also make a comparison to Kawasaki disease. I wonder if there also a virus involved but it's not contagious and only kids are affected.

[@user-gr1vd3gh6p]

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[@hstudy8406]

Great Sir

[@hantonoshi]

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[@mohammadtaani3194]

can u make a video to explain POTASSIUM disorders plz

[@annotatedmedicaltutorials858]

Hepatorenal syndrome usually occurs just 1year after diagnosis of Liver Cirrhosis in approximately 18% of the patients, and in 39% of the patients it occurs after 5years of diagnosis of Liver Cirrhosis

[@dianapennepacker6854]

I got it after HE, induced coma, and then had about 9 liters of ascities in me for days on end before finally receiving a paracentesis. I believe the shock to my system just was too much or something - as I hear AKI often happens after induced coma and hepatic encephalopathy. Then removing all that fluid at once. I can deal with dialysis. I can deal with doctors, lethargic, nausea, lactulose, bi weekly paracentesis, and feeling gross - oh and low sodium. I however hate- ABSOLUTELY hate the fact I can't produce urine and the constant state of dehydration. If I get a transplant I'm celebrating by getting an ice cold jug of chocolate lactaid protein milk and sipping on it to my little hearts content. Then set up a blind taste test for water. Then buying 100 different juices and mix and matching till I find the right drink. I will never ever be dehydrated again! I need to gain weight but eating is getting more difficult. It would be so much easier to just be able to make a smoothie. Sorry for the rant. Damn I wish they knew how to just have my body make urine even if I still need dialysis.

[@shivasingh5104]

what stationary do you guys use>>

[@niharnayak1614]

Nice

[@Be1smaht]

This was a uworld question for me today

[@salmahossam1447]

can we use diuretics to treat the ascites ?

[@YasserALHarbi43]

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[@aaryanmishra9279]

Why does all the h2o and Na leak out causing ascites in liver disease in the tubules

[@theeducatorsacademy2083]

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[@razeenriyasat254]

Just a query, shouldn't the Cardiac output decrease? . Since there is systemic vasodilation, the cardiac return to the heart will decrease hence according to frank-starlings law, the cardiac output should decrease.

[@brbmd7414]

Yes, but that is only part of the picture. Baroreceptors will detect the drop in cardiac output and cause a compensatory increase in sympathetic tone.

[@AKhan-ux9fk]

Decrease in blood pressure will cause reflex increase in cardiac output

[@francismartino6890]

Is this the same for dogs

[@Lino_Winter]

Hey, I have one question: How does the NO get to the arteries of the splanchnic system, or why does it effect it specifically? Since it must get trough the cardiovasular system first, it should in my mind also get to the arteries of the lungs, the heart itself, etc .Could you explain this? English isn't my mother tongue so I may not understand everything. Greetings

[@AKhan-ux9fk]

There's shunting of blood to systemic system due to portal hypertension that causes NO to act only on splanchnic vessels and cause thier vasodilation I hope now you understand

[@anwesha_ks]

Is it alcoholic liver. Sir what is alcoholic liver and what are the threatens on it? I am a nutrition student,but missed that class in college..

[@jameslim3641]

When a person has chronic alcoholic abuse, it will cause steatohepatitis, and may progress to hepatitis, then to cirrhosis. Alcohol is metabolised to acetaldehye in liver and this is extremely toxic as it can bind to protein and nuclei acid and change their structure

[@aksnstha7051]

Does obstructive jaundice cause HRS?

[@user-wv7se3ko9x]

Yes

[@Jac2788]

My mother died of this in 2017 😞

[@yogayantra]

and what are the causes??? You see, you draw a person who obviously is overweight. I believe that diet can have a major impact, that a poor diet started the disease, and probably a better diet could reduce the problem, from its root. Right?

[@sergioramos6455]

Are you a doctor? It's obvious that the content creator chose to mainly focus on the analysis of the pathophysiology, which is great for educational punctual purposes.

[@yogayantra]

@@sergioramos6455 i think that the study of any disease should include the ethiology

[@yogayantra]

@@sergioramos6455 and do i need to be a doctor to be allowed to ask a question?

[@vsear5911]

The proximal cause is cirrhosis->liver failure. If, in turn, you want to know the etiopathology of that, that's for a cirrhosis video. Not within the scope of a syndrome overview.

[@sergioramos6455]

But he still mentions different causes... I didn't ask that in a non respectful manner, I was just curious.

[@doctorashutosh]

1st comment😂

[@roseart7485]

*virtual high fives* :D

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[@fanzone59]

This is definitely the worst explanation of the topic I've seen on the net. He was obviously tired when he made this video because it's very confusing and doesn't contain the required sequence of information.