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18 September 2017 : Case report  Japan

A Case of Hepatorenal Syndrome and Abdominal Compartment Syndrome with High Renal Congestion

Rare coexistence of disease or pathology

Hiroteru Kamimura1AEF, Takayuki Watanabe1B, Tomoyuki Sugano1BC, Nao Nakajima1B, Junji Yokoyama1D, Kenya Kamimura1D, Atsunori Tsuchiya1D, Masaaki Takamura1D, Hirokazu Kawai1D, Takashi Kato2BD, Gen Watanabe2B, Satoshi Yamagiwa1DE, Shuji Terai1A

DOI: 10.12659/AJCR.904663

Am J Case Rep 2017; 18:1000-1004

Abstract

BACKGROUND: Hepatorenal syndrome (HRS) is a reversible renal impairment that occurs in patients with acute liver failure and advanced liver cirrhosis. HRS is due to a renal vasoconstriction that results from extreme vasodilatation. It is therefore a functional disorder, not associated with structural kidney damage. On the other hand, end-stage liver diseases are often complicated by massive ascites. Massive ascites may cause abdominal compartment syndrome (ACS), which includes impairment of renal blood flow, but there are no reports indicating that kidney lesions caused by ACS may pathologically contribute to end-stage liver diseases.

CASE REPORT: A 40-year-old man with acute liver failure was admitted to our hospital. He was diagnosed with type 1 HRS and showed ACS at the same time. He died 30 days after admission. There were signs of congestion in the kidneys upon dissection and advanced erythroid fullness in the renal tubules.

CONCLUSIONS: We report an autopsy case with HRS and ACS diagnosed with a clinical and histopathological consideration of liver and kidney. Further clinical studies are needed to improve management of renal failure in patients with acute liver failure and advanced liver cirrhosis.

Keywords: hepatorenal syndrome, intra-abdominal hypertension

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923