الفهرس 
Hepatorenal SyndromeOnly 14 pages are availabe for public view
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Abstract
Advanced cirrhosis is a condition characterized by impaired liver
function, portal hypertension, increased splanchnic blood volume,
hyperdynamic state with increased cardiac output, systemic vasodilatation,
a state of decreased central blood volume, and systemic inflammatory
response. Acute kidney injury (AKI) is one of the most severe
complications of cirrhosis, occurring in up to 50% of hospitalized patients,
and has been associated with higher mortality, which increases with
severity of AKI (Francoz et al., 2019).
Hepatorenal syndrome is one of the types of AKI that occurs in
patients with advanced cirrhosis and is characterized by decreased Renal
blood flow that is unresponsive to volume expansion. Hepatorenal
syndrome is associated with significant health care resource utilization,
with an estimated annual total direct medical cost in the United States of
approximately $4 billion dollars (Angeli et al., 2019).
The incidence of hepatorenal syndrome in patients with
decompensated liver disease is approximately 4%. Most of these patients
have portal hypertension from alcoholic hepatitis, cirrhosis, or metastatic
cancers. The cumulative probability of developing hepatorenal syndrome
(HRS) at 1 year is 18% and at 5 years is 39% in patients with
decompensated liver disease. The highest risk patients were those with
hyponatremia and high plasma renin activity. One third of patients that
have spontaneous bacterial peritonitis may have HRS (Ranasinghe et al.,
2020).
Patients with HRS present with.