vi medicine informatics




A patient’s decreased urine output, azotemia, and acute increase in serum creatinine in the setting of liver disease raise concern that he may be experiencing hepatorenal syndrome. Hepatorenal syndrome is a progressive functional renal failure caused by a reduction in the glomerular filtration rate due to declining liver function. It is characterized by splanchnic vasodilation and concomitant vasoconstriction in the renal vascular beds caused by the production of mediators and the activation of the renin-angiotensin-aldosterone system. The combination of these two factors causes a prerenal type of azotemia, evidenced by the patient’s blood urea nitrogen/creatinine ratio > 21 and a fractional excretion of sodium (FeNa) of 0.3%. Size and Shape of the Kidneys would be normal.

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