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Published on: November 7, 2017
Hepato-Cardio-Renal Syndrome
Abhilash Koratala1, Frederik Verbrugge2, Amir Kazory3
1Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI.
Insights
Hepatorenal syndrome may involve heart dysfunction preceding kidney disease, suggesting a hepato-cardio-renal link. This challenges traditional views, highlighting the heart
Area of Science:
- Cardiology
- Hepatology
- Nephrology
Background:
- Hepatorenal syndrome (HRS) is a complex multisystem disorder linking cirrhosis to kidney dysfunction.
- Cardiac abnormalities are increasingly recognized in patients with advanced liver disease.
Purpose of the Study:
- To investigate the role of cardiac dysfunction in the development of kidney disease in patients with cirrhosis.
- To re-evaluate the pathophysiology of hepatorenal syndrome.
Main Methods:
- Review of recent advances in cardiac studies in patients with liver disease.
- Analysis of accumulating data on the temporal relationship between cardiac and kidney dysfunction.
Main Results:
- Subtle cardiac abnormalities are common in patients with advanced liver disease and cirrhosis.
- Cardiac dysfunction often precedes and predicts the development of kidney disease in these patients.
- These findings challenge the view that cardiac issues are merely a consequence of hepatorenal interactions.
Conclusions:
- The heart plays a key role in hepatorenal syndrome.
- Hepatorenal syndrome may represent a hepatic form of cardiorenal syndrome (hepato-cardio-renal syndrome).
- Liver disease can impact kidney function via cardiorenal pathways.
Abstract:
Hepatorenal syndrome has conventionally been regarded as a multisystem syndrome in which pathophysiologic pathways that link cirrhosis with impairment in kidney function are followed by dysfunction of several organs such as the heart. The advances in cardiac studies have helped diagnose more subtle cardiac abnormalities that would have otherwise remained unnoticed in a significant subset of patients with advanced liver disease and cirrhosis. Accumulating data suggests that in many instances, the cardiac dysfunction precedes and predicts development of kidney disease in such patients. These observations point to the heart as a key player in hepatorenal syndrome and challenge the notion that the cardiac abnormalities are either the consequence of aberrancies in hepatorenal interactions or have only minor effects. As such, the disturbances traditionally bundled within hepatorenal syndrome may indeed represent a hepatic form of cardiorenal syndrome whereby the liver affects the kidney in part through cardiorenal pathways (that is, hepato-cardio-renal syndrome).
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