Hepatorenal syndrome

　　In advanced liver cancer, it often causes idiopathic, progressive, pre-renal renal failure due to severe liver failure, and the renal histology may show no obvious or only mild non-specific changes, known as liver-kidney syndrome, which refers to the sudden onset of unexplained oliguria and azotemia in patients with advanced liver cancer without a history of renal disease.

　　1. Increased renal sympathetic nerve tension

　　In severe liver cirrhosis or advanced liver cancer, when liver cells are widely damaged, leading to severe liver dysfunction, ascites, dehydration, upper gastrointestinal bleeding, and paracentesis can all lead to a decrease in effective circulating blood volume, reflexively increasing the excitability of the sympathetic-adrenal medulla system, causing the afferent arterioles to constrict, the synthesis and secretion of renin to increase, and the concentration of catecholamines in the blood to rise, leading to a decrease in glomerular filtration rate, and triggering functional renal failure.

　　2. Increase in false neurotransmitter

　　Liver failure, the metabolic products in the blood cannot be cleared, and the false neurotransmitter replaces the normal terminal sympathetic neurotransmitter, causing the tension of the peripheral blood vessels to decrease, resulting in dilation of small arteries, blood pressure drop, decreased renal blood perfusion, decreased glomerular filtration rate, leading to liver-kidney syndrome.

　　Complications include liver failure, gastrointestinal bleeding, infection, hyperkalemia, and other conditions.

　　One, liver function failure

　　1. A clinical syndrome that occurs due to widespread and severe damage to liver cells, with severe disturbance of metabolic function in the body, commonly known as liver failure. Liver failure occurs in many severe liver diseases, with a dangerous prognosis and poor prognosis.

　　2. Patients may have symptoms such as hepatic encephalopathy, jaundice, bleeding, brain edema, ascites, etc.

　　Two, gastrointestinal bleeding:Clinical symptoms include hematemesis (dark red or bright red) and melena. During liver cirrhosis, due to fibrosis and proliferation of connective tissue in liver tissue, blood vessels in the liver are damaged, causing obstruction and leading to obstruction of portal venous blood flow.

　　Three, infection:Patients with liver-kidney syndrome are susceptible to bacterial and toxic invasion due to decreased resistance and decreased immune function of the body.

　　Four, hyperkalemia.

　　HRS patients have clinical manifestations of primary liver cirrhosis and portal hypertension before or at the onset of the disease, common symptoms include anorexia, abdominal distension and other gastrointestinal symptoms. When azotemia occurs, nausea and vomiting may occur, with varying degrees of jaundice; most patients have refractory ascites, oliguria is the most common manifestation.

　　The clinical manifestations of liver and kidney syndrome are mainly in addition to the manifestations of primary liver disease such as splenomegaly, jaundice, and liver dysfunction, there are progressive azotemia, oliguria, hyponatremia, and hypokalemia. It is divided into three stages: clinical stage.

　　1, Pre-azotemia stage

　　Liver decompensation, blood BUN, Cr normal or slightly high, Na+ decreased, progressive oliguria, insensitive to diuretics.

　　2, Azotemia stage

　　Significant increase in blood BUN, moderate increase in Cr, and further decrease in Na+.

　　3, Terminal stage

　　Anuria, blood pressure drop, and even deep coma.

　　The prognosis of this disease is not good, and most patients die of various complications due to liver or renal failure within 3 to 10 days after the onset of liver and kidney syndrome.

　　Type I HRS has a very poor prognosis, with an average survival period of 2 weeks. Type II HRS has a better prognosis, with an average survival period of 6 months.

　　Recent reports show that the use of vasopressin (omipressin) or terlipressin (terlipressin) with or without albumin in the treatment of HRS patients shows significant improvement in renal function.

　　One, Urinalysis

　　Urine protein negative or trace, urine sediment normal or may have a small amount of red blood cells, white blood cells, transparent, granular casts or renal tubular cell casts.

　　Two, Urinalysis

　　Urine specific gravity is usually >1.020, urine osmolality >450 mmol/L, urine/blood osmolality >1.5, urine sodium is usually

　　Three, Blood Biochemical Examination

　　1, Hyponatremia.

　　2, Low blood chloride.

　　3, BUN and Scr increased.

　　4, Liver function: ①ALT increased; ②Albumin decreased; ③Bilirubin increased; ④Cholesterol decreased; ⑤Blood ammonia increased.

　　One, Suitable Foods:Light and easy-to-digest foods, fresh vegetables and moderate amounts of fruit, drink water appropriately, and control the intake of high-protein foods (such as lean meat, milk, eggs, etc.). Winter melon, watermelon, and luffa can promote diuresis, red bean soup, black bean soup, mung bean soup, and sugar can clear heat and promote diuresis. Honey, bananas, fresh pears, radishes, walnuts, black sesame seeds, can moisten intestines and promote defecation, these foods can be used in combination with medicine and used regularly.

　　Two, Unsuitable Foods:Avoid drinking alcohol and spicy foods, eat less greasy and animal protein-rich foods (such as fatty meat, shrimp, crab, etc.), and avoid eating beans and their products (such as tofu, sprouts, bean powder, etc.).

　　Three, Food Therapy Formula:

　　1, Wu Wei and Du Zhong Stewed Goat Kidney Soup

　　Ingredients: 2 goat kidneys, 15 grams of Du Zhong, 6 grams of Wu Wei Zi.

　　Preparation: Cut the goat kidney to remove the fat membrane, wash and slice. Wash and clean Du Zhong and Wu Wei Zi. Put all the ingredients together in a stew pot, add an appropriate amount of boiling water, simmer over low heat for 1 hour, season and eat.

　　2, Yam, mung bean, and euryale soup

　　Ingredients: Dried yam 25 grams, mung beans 15 grams, euryale seeds 25 grams, lotus seeds 20 grams, a little sugar.

　　Preparation: Put the above 4 ingredients into the pot, add an appropriate amount of water, simmer until done, and then add sugar to taste. Take one dose a day, and take 5 doses as one course.

　　3. Winter Melon and Pork Kidney Soup

　　Ingredients: Winter melon 250 grams, pork kidney 1 pair, mung bean seed 9 grams, Astragalus 9 grams, Chinese yam 9 grams, mushrooms 5 pieces, chicken broth 10 cups.

　　Preparation: Wash the ingredients, peel and remove the core of the winter melon, cut into pieces, and remove the stem of the mushrooms. Cut the pork kidney in half, remove the white part, and then cut into slices, wash, and blanch with hot water. Heat the chicken broth in the pot, add ginger and scallions first, then add mung bean seed, Astragalus, and winter melon, and boil over medium heat for 40 minutes. Then add the pork kidney, mushrooms, and Chinese yam, and boil until done, and then simmer over low heat for a few minutes, and season with salt to taste.

　　1. Treatment of the Underlying Disease

　　Since the renal failure of this disease is functional, actively improving the patient's liver function has a good effect on improving renal function. Under the condition allowed, it is advisable to actively take surgery, radiotherapy, chemotherapy, interventional therapy, and other treatments for liver tumors and liver cirrhosis.

　　2. Supportive Therapy

　　Discontinue any drugs that induce azotemia and damage the liver, provide a low-protein, high-sugar diet, alleviate the progression of azotemia and hepatic encephalopathy, and use liver-protecting and enzyme-lowering drugs at the same time.

　　3. Eliminate the Cause

　　Upper gastrointestinal bleeding, liver cancer rupture bleeding, large amount of ascites, high-dose diuretic use, severe infection, surgery, and others are common causes of hepatorenal syndrome, which should be prevented and treated in a timely manner.

　　4. Correction of Electrolyte and Acid-Base Balance

　　On the basis of replenishing effective blood volume, increase urine output and urinary sodium excretion, actively correct K+, Na+, Cl+, Mg+, and acid-base imbalance.

　　5. Volume Expansion Therapy

　　Use plasma, whole blood, albumin, or dextran and other plasma preparations for volume expansion, while giving furosemide and others to reduce vascular resistance and improve renal blood flow. If the pulmonary capillary wedge pressure is not normal, it is not advisable to expand volume.

　　6. Application of Vasoactive Drugs

　　The application of dopamine and phentolamine can dilate renal blood vessels, improve renal blood flow, and reduce renal vascular resistance.

　　7. Prostaglandin PI and 654-2

　　It has a protective effect on the kidneys.

　　8. Traditional Chinese Medicine Treatment

　　The preparation of Salvia miltiorrhiza injection for intravenous drip can treat functional renal failure and reduce BUN levels.