Journal of Kidney

A Case Report on Hepatorenal Syndrome

Divyashree Rangari, Madhuri Shambharkar, Achita Sawarkar^*, Pratibha Wankhade and Jaya Khandar ^*Correspondence: Achita Sawarkar, Department of Nursing, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India, Email:

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Introduction

In patients with cirrhosis and ascites, the hepatorenal syndrome (HRS) is defined as a possibly irreversible kidney failure [1]. HRS is a kind of progressive kidney failure found in persons with severe liver impairment, which is most commonly caused by cirrhosis. Toxins begin to build up in the body when the kidneys quit working. This eventually leads to liver failure. HRS is caused by a renal vasoconstriction, which is cause for concern because HRS has a significant death rate if left untreated. In contrast to type 2 HRS, which is associated with a median survival time of two to four weeks in patients with untreated type 1 HRS, with 95 percent of such patients dying within the first 30 days of onset, type 1 HRS is associated with rapid progression to renal failure over as little as two weeks. The median survival time for patients with type 2HRS is 6 months [2]. In2005, the International Ascites Club (IAS) published a revised set of criteria to aid in the diagnosis of HRS. We offer a unique case of hepatorenal syndrome with a positive result. a distinctive presentation [3].

Flint first identified hepatorenal syndrome (HRS) in 1863 as a link between liver disease and oliguric renal failure in the absence of considerable renal histological change. In the absence of other causes of renal failure, it is defined by a significant decrease in glomerular filtration rate (GFR) and renal plasma flow in patients with liver cirrhosis and hepatic failure. Vasoconstriction occurs as a result of systematic vasodilation, and HRS patients are expected to recover from renal failure after a liver transplant [4].

Patient identification

A male patient 41-year-old from wardha, was admitted in AVBRH on 25/6/21 ward on micu diagnosed as the case of hepatorenal syndrome.

Present medical history: My patient aged 41 yr male was admitted to MICU. AVBRH on 25/06/21 for the patient he had complaint of abdominal pain, lower extremity, distension of abdomen her haemoglobin level at the time admission was 9.7 gm%.

Past medical history: Hepatorenal syndrome and alcoholic cirrhosis. He was hospitalised with swelling in his lower extremities and abdomen.

Family history: My patient’s family comprise six members. He was diagnosed to heptorenal syndrome with no abnormal genetic history from family. And other family member doesn’t have any complaints regarding their health.

Past interventions and outcome

Clinical finding: Abdominal pain headache distention of abdomen nausea, vomiting, loose stool, cough, cold, loss of consciousness and chronic alcoholism since in 20 yr last intake backache, fever

Physical examination: Temperature is 36 degrees Celsius, blood pressure is118/68, pulse is110, and weight is 50 kilogrammes. He appeared to be attentive and oriented, with no signs of discomfort. His pupils were circular and equal. The abdomen was swollen, and there was a normal bowel sound. He developed edema and swelling on one of his limbs.

Diagnostic assessment

Blood test: Hb -9.5 gm% Albumin 2.3, kft -128

Ultrasonography: Large esophageal varices done.

Management

Medical management

My patient admitted in AVBRH hospital on dated 26/06/21 and prescribed medication Tab laxis 40mg, Tab cipla 40 mg, Tab thamne, Inj vit k 10 mg OD, Tab Neurobim pan–OD

Inj pan 500mg BD, inj Albumin 20% BD, INJ optineurin 1ampu OD ijn cefotaxime 2gm TDS

Nursing management

This case belongs to medicine as well as the as MICU department therefore using care played a vital role in every aspect.

Surgical management

No any surgery perform of patient.

Nursing diagnosis (Table 1-3)

Table 1: Pain in the abdomen related to hepatorenal syndrome.

Table 2: Low nutritional pattern less than body requirement related to pain perception secondary related to abdomen pain.

Table 3: Sleeping pattern related to disease condition and hospitalization.

Follow up: Advice the patient to visit the hospital on after one month

He has prescribed to take. Tab laxis 40mg, Tab cipla 40 mg, Tab thamne, and Tab Neurobim pan –OD

The advice was also patient

1. Prevent the infections

2. Maintain the personal hygiene

3. Proper rest and sleep

4. Intake the healthy diet.

5. Regular follow up.

Diagnosis

A 41-year male patient admitted in MICU in AVBRH on dated 26/06/21 the chief complaint is abdomen pain and swelling on lower extremities and vomiting shortness of breath. Although HRS diseases cause irreversible renal dysfunction, such as hepatitis C virus-induced cryoglobulinemia, membranoproliferative glomerulonephritis, HRS causes reversible renal failure. HRS is difficult to clinically distinguish from primary renal failure. According to the definition of HRS from the International Ascites Club (IAC) proposed in 2007, HRS is divided into 2 types (1 and 2) based on prognosis and clinical characteristics. The patient had no reaction to rehydration therapy and albumin administration, and he had no previous history of renal dyes-function [5]. He had recovered from bacteremia and his blood pressure was maintained. Clinically, he was originally diagnosed as HRS. We did not find major evidence of renal tubule necrosis in the autopsy; otherwise, we found some bile casts caused by elevation of serum bilirubin, which affect renal function. To maintain effective plasma circulation, an albumin infusion is first performed. In addition, albumin treatment is combined with terlipressin as the first-line treatment, or midodrine and nor-adrenaline are used as alternatives. We administrated nor-adrenaline, which was permitted by health insurance. A number of related studies were reviewed [6-11].

Conclusion

My patient aged 41 yr male was admitted to MICU. AVBRH on 25/06/21 for the and patient was diagnosed with hepatorenal syndrome case he had complaint of abdominal pain distention of abdomen the patient advised for follow up care once month.

References

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