Patients with the hepatorenal syndrome can be separated into 2 types based on clinical findings. The prognosis for both types is poor unless a liver transplant can be performed or the precipitating factors for disease progression can be avoided.
Patient selection: liver disease with cirrhosis and ascites
Type I:
(1) advanced liver disease
(2) acute deterioration in renal function over days or week
(3) half of the patients will have a precipitating factor and half will not
where:
• Precipitating factors include: GI hemorrhage, infection, dehydration from paracentesis or overdiuresis, surgery or drug exposure.
• According to Bataller et al (Table 2, page 239), a rapid deterioration in renal function is defined by a doubling of the serum creatinine to a level > 2.5 mg/dL or a 50% reduction in the creatinine clearance to < 20 mL/min in less than 2 weeks.
Type II:
(1) preserved liver function
(2) slow but progressive deterioration in renal function
(3) usually have diuretic resistant ascites
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