Abstract

GIRALDO OCAMPO, Christian Camilo; JIMENEZ BEJARANO, María Fernanda  and  TORRES SALTARIN, Jaime José. Hepatorrenal syndrome in acute on chronic hepatic failure. Rev. colom. nefrol. [online]. 2021, vol.8, n.2, e704.  Epub Jan 01, 2022. ISSN 2500-5006.  https://doi.org/10.22265/acnef.8.2.532.

Acute-on-chronic liver failure (ACLF) is a recently characterized entity that presents as an acute decompensation of chronic liver disease. It can be associated with failure in different organs and presents a high mortality rate. Its incidence reaches up to 30% on patients consulting for complications derived from cirrhosis.

Among the most frequent precipitating factors, there are bacterial infections, alcoholism, and reactivation of viral hepatitis; however, in up to 40% of the cases, no precipitating factor is identified. The pathophysiology of this entity is still unknown to a certain extent, but the existence of an excessive inflammatory response in its development is suggested.

There is no specific treatment and its management is based on treatment for associated complications, support, and finally liver transplantation.

Kidney dysfunction is a common finding in patients with liver disease. The understanding of the pathophysiology of this entity, previously thought to be purely functional in nature, yet now given the evidence of some degree of related tubular damage, has improved and has recently entailed a rethink of the diagnostic criteria and the classification of the illness.

We describe the clinical case of a patient treated at a hospital in the city of Pereira, Risaralda, who presented bacteremia due to Gram-positive cocci of unclear origin, considered as the precipitating factor. The patient had clinical deterioration, as well as the onset of hepatorenal syndrome and multi-organ failure, finally leading to death despite multidisciplinary treatment.

Keywords : cirrhosis; hepatic failure; hepatic encephalopathy; hepatorenal syndrome; liver transplantation..

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