hepaticrenal

Hepaticrenal is a term used to describe the functional and pathophysiological interplay between the liver and kidneys. It is not a formal medical diagnosis on its own but is sometimes used in medical literature to refer to conditions that involve both organ systems, most notably the hepatorenal axis seen in advanced liver disease.

Among the most studied manifestations is hepatorenal syndrome (HRS), a functional kidney failure that occurs in the setting of cirrhosis or acute liver failure. In HRS, renal dysfunction arises primarily from hemodynamic changes and reduced renal perfusion rather than intrinsic kidney injury, although sustained kidney dysfunction can progress and complicate liver disease.

Pathophysiology centers on systemic and splanchnic vasodilation caused by liver dysfunction, which lowers effective arterial blood volume. Compensatory activation of the renin-angiotensin-aldosterone system, sympathetic nervous system, and antidiuretic hormone leads to renal vasoconstriction and diminished glomerular filtration rate. Inflammation and circulatory dysregulation contribute to further impairment.

Clinical features include reduced urine output, low sodium excretion, and rising serum creatinine in a patient with cirrhosis or liver failure. Urinalysis may show minimal sediment and normal kidney size on imaging, helping distinguish HRS from intrinsic kidney disease.

Management focuses on treating the underlying liver disease and supporting renal function. Therapies may include volume expansion with albumin, vasoconstrictor medications, avoidance of nephrotoxins, and, when feasible, liver transplantation. Renal replacement therapy is considered in select cases; overall prognosis depends on liver disease severity.