[Renal disorders in hepatic insufficiency - pathogenesis and therapy (author's transl)]

Renal failure in patients with acute or chronic hepatic insufficiency may be caused by prerenal factors (diuretics, hemorrhage), acute renal failure (shock, toxic tubular necrosis) or concurrent primary renal disease. Prerenal (functional terminal or circulatory) insufficiency to the kidneys seems to occur spontaneously; it is characterized by progressive reduction of glomerular filtration rate and renal plasma flow due to vasoconstriction and increase of intrarenal arterial resistance; the pathogenetic mechanisms of these changes are unknown. Reduction of effective plasma volume is especially important. Attempts at pharmacologically influencing renal blood flow have failed up to now. Increase of plasma volume and furosemide medication are therapeutic procedures worthwhile trying. Hemodialysis is indicated only, if restitution of liver function can be expected.