Proposed Pathophysiology and Triggers of Hepatorenal Syndrome - Flowchart
Proposed Pathophysiology and Triggers of Hepatorenal Syndrome - Flowchart Hepatorenal Syndrome Hepatorenal Syndrome
«Flowchart»

Start

Start

Start

Cirrhosis and portal hypertension

Cirrhosis and portal hypertension

Cirrhosis and portal hypertension Cirrhosis and portal hypertension

CCM?

CCM?

CCM? CCM?


Diarrhea
Diuretics
GI bleeding
Large-volume paracentesis
SBP/sepsis
Hepatic dysfunction


Diarrhea
Diuretics
GI bleeding
Large-volume paracentesis
SBP/sepsis
Hepatic dysfunction


Diarrhea
Diuretics
GI bleeding
Large-volume paracentesis
SBP/sepsis
Hepatic dysfunction Diarrhea


ACEIs
ARBs
NSAIDs


ACEIs
ARBs
NSAIDs


ACEIs
ARBs
NSAIDs ACEIs

Inflammation, bacterial translocation, and vasoactive mediators

Inflammation, bacterial translocation, and vasoactive mediators

Inflammation, bacterial translocation, and vasoactive mediators

Splanchnic and peripheral vasodilatation

Splanchnic and peripheral vasodilatation

Splanchnic and peripheral vasodilatation

Effective circulatory volume
Blood pressure
Cardiac output

Effective circulatory volume
Blood pressure
Cardiac output

Effective circulatory volume
Blood pressure
Cardiac output



Na+/H2O retention

Na+/H2O retention

Na+/H2O retention

+ 2

Renal perfusion

Renal perfusion

Renal perfusion

Hepatorenal syndrome

Hepatorenal syndrome

Hepatorenal syndrome

Hepatorenal syndrome

End

End

End

Renal vasoconstriction and a reduction in GFR

Renal vasoconstriction and a reduction in GFR

Renal vasoconstriction and a reduction in GFR

ACEIs, angiotensin-converting enzyme inhibitors; ADH, antidiuretic hormone; ARBs, angiotensin receptor blockers; CCM, cirrhotic cardiomyopathy; GFR, glomerular filtration rate; GI, gastrointestinal; NSAID, nonsteroidal antiinflammatory drug; RAAS, renin-angiotensin-aldosterone system; SBP, spontaneous bacterial peritonitis; SNS, sympathetic nervous system.

ACEIs, angiotensin-converting enzyme inhibitors; ADH, antidiuretic hormone; ARBs, angiotensin receptor blockers; CCM, cirrhotic cardiomyopathy; GFR, glomerular filtration rate; GI, gastrointestinal; NSAID, nonsteroidal antiinflammatory drug; RAAS, renin-angiotensin-aldosterone system; SBP, spontaneous bacterial peritonitis; SNS, sympathetic nervous system.

ACEIs, angiotensin-converting enzyme inhibitors; ADH, antidiuretic hormone; ARBs, angiotensin receptor blockers; CCM, cirrhotic cardiomyopathy; GFR, glomerular filtration rate; GI, gastrointestinal; NSAID, nonsteroidal antiinflammatory drug; RAAS, renin-angiotensin-aldosterone system; SBP, spontaneous bacterial peritonitis; SNS, sympathetic nervous system.

ACEIs ADH ARBs CCM GFR GI NSAID RAAS SBP SNS

RAAS and SNS activity, plasma ADH

RAAS and SNS activity, plasma ADH

RAAS and SNS activity, plasma ADH

Na+/H2O retention

Na+/H2O retention

+ 2 Na[+]

Renal vasocontriction and a reduction in GFR

Renal vasocontriction and a reduction in GFR

Renal vasocontriction

Ascites/hyponatremia

Ascites/hyponatremia

Ascites/hyponatremia

Renal vasoconstriction and a reduction in GFR

Renal vasoconstriction and a reduction in GFR

Renal vasoconstriction