Case Report on AKI on CKD and Hepatic Renal Syndrome

Abstract

Hepatorenal syndrome (HRS) is a severe form of kidney dysfunction associated with cirrhosis and portal hypertension. It is characterized by renal vasoconstriction without significant histological changes in the kidneys, leading to renal failure. This case report discusses a 72-year-old male with a history of decompensated chronic liver disease (DCLD) and HRS, presenting with abdominal pain, distension, decreased urine output, shortness of breath, and pedal edema. The patient had a history of gastrointestinal bleeding, recurrent blood transfusions, and poor dietary habits, including chronic alcohol consumption and smoking. Laboratory findings revealed elevated blood urea, serum creatinine, and uric acid, indicating impaired renal function. Severe anemia and neutrophilic leukocytosis suggested chronic disease and an active infection, likely spontaneous bacterial peritonitis (SBP). Imaging studies showed gallbladder wall edema, ascites, and Grade 3 esophageal varices, confirming portal hypertension. The patient was diagnosed with decompensated cirrhosis, acute kidney injury superimposed on chronic kidney disease, anemia of chronic disease, and suspected SBP. Management involved a multidisciplinary approach, including nephrology and hepatology specialists. The treatment plan included antibiotics (cefotaxime and metronidazole) to treat SBP, medications to control portal hypertension (octreotide and carvedilol), erythropoietin for anemia, and supportive treatments for hepatic encephalopathy. Despite aggressive management, the prognosis remains poor, emphasizing the need for early liver transplantation in patients with advanced HRS. This case highlights the complex interplay of liver and kidney dysfunction in cirrhosis and underscores the importance of early intervention and multidisciplinary care in improving patient outcomes.

Keywords: Hepatorenal Syndrome (HRS), Decompensated Chronic Liver Disease (DCLD), Acute Kidney Injury (AKI), Spontaneous Bacterial Peritonitis (SBP), Portal Hypertension