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Cardiogenic Hepatorenal Syndrome

Department of Internal Medicine "A," Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Daniel Yeshurun

Department of Internal Medicine "A," Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Julio Shahar

Department of Internal Medicine "A," Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

A variant of hepatorenal syndrome occurring in patients with chronic conges tive heart failure following an episode of cardiogenic pulmonary edema, and in the absence of hypotension, is described. This was observed in 13 patients during an eleven-year period. The clinical picture is characterized by hepatic injury and functional renal impairment. Increase of serum glutamic oxaloacetic transami nase levels as high as 2100 IU; prolongation of prothrombin time; elevation of serum bilirubin, creatinine, blood urea nitrogen, and potassium levels; decrease in urinary sodium excretion; and a normal urinary sediment are the salient laboratory abnormalities of this entity. Treated with convential medication, the patients' course was fatal in 4 cases. When the splanchnic vasodilator dopamine was added to the patients' management, 5 of 9 patients recovered. Cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure. The apparently beneficial effect of low-dose dopamine needs further evaluation.

Angiology, Vol. 41, No. 11, 893-900 (1990)
DOI: 10.1177/000331979004101101


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