Etiology :-
HRS usually develops in hospitalized patient, indicating that
iatrogenic factors are playing important role in the pathogenesis of this
disorder.
Abdominal paracentesis, vigorous diuretic therapy and bleeding-
especially gastrointestinal-are known precipitating factors. Sometimes
HRS is idiopathic.
Clinical features of HRS
The patient usually presents with manifestations of advanced liver
disease and on development of HRS, there will be further progression of
the bad general condition, disturbance of consciousness, mental
concentration, increase in oedema, ascites and progressive oliguria and
even anuria. Laboratory assessment will show a progressive increase in
serum creatinine and blood urea.
Differential Diagnosis:
HRS should be differentiated from other causes of azotaemia in
patient with advanced liver disease especially prerenal azotaemia and
acute tubular necrosis. The following table presents the important
differentiating points.