Incidence
Age
Sex
Geography
Aetiology	- extreme peripheral vasodilatation ? due to NO --> decrease in effective blood volume and hypotension ---> rise inplasma renin, aldosterone, angiotensin, noradrenaline ----> vasoconstriction of renal vasculature, blood flow directed away from renal cortex -----> reduced GFR, plasma renin remains high; salt and water retention; small output of hypotonic urine - can progress from this "functional" disease to acute tubular necrosis - other possible mediators include eicosanoids; inhibitors of prostaglandin synthesis e.g. NSAIDS can precipitate hepatorenal syndrome
Presentation	- seen in patients with advanced cirrhosis with jaundice and ascites - small output of hypotonic urine 0 maybe precipitated by vigorous diuretic therapy, diarrhoea or paracentesis
Investigations
Macro
Micro	- in "functional" hepatorenal syndrome, histology is almost normal
Staging
Serum markers
Management	Medical - stop diuretics - fluids - correct intravascular hypovolaemia Surgical - TIPS can produce short-term improvement - liver transplantation
Prognosis	- liver transplantation gives best long-term prognosis - similar to patients without renal failure
Complications

Hepatobiliary medicine

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