Management of Renal Complications of Liver Disease

Abstract

Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive.

Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.