Talk:Hepatorenal syndrome

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[edit] prognosis

I reverted 'slightly' to the 'slightly better prognosis' with HRS2, as the prognosis is still ghastly, whether or not they on average last for another few months. I think it's important to bear in mind that patients and relatives will read these articles when they or their loved ones are sick-and we should avoid giving falsely positive impressions of the outcome of this disorder, of which I cannot think of one good outcome in all the cases I've seen professionally over the last ten years.Felix-felix 07:17, 24 July 2006 (UTC)

I disagree on the word "slightly" for one reason: It's agreed that prognosis is poor with Type II HRS (<6/12) but, this data is almost all from the pre-liver transplant era. Practically, the difference now is the time to transplant, which is the major determinant to long term prognosis. The prognostic figures on T1 and T2 HRS commonly cited are from the Barcelona series (PMID 8514039) published in 1993, which was also presented in graph schematic form in their Lancet review (PMID 14654322 -- the same graph is copied in most reviews on HRS since). Some of this was done in the era pre-OLTx, and almost all was before the availability of LRDLTx.
Type I HRS patients are so ill that, especially in organ-deficient areas, a large percentage still don't make it to transplant (even when dialysis supported). Type II HRS patients, on the other hand, do have time to make it. At my centre, in the past five years we've transplanted at least 40 patients on an accelerated basis with type II HRS (diuretic resistant ascites and renal failure). In practical terms in my area, T2 HRS results in admission to hospital, and a higher priority for transplantation, which, now, is becoming feasible. -- Samir धर्म 09:25, 24 July 2006 (UTC)
You guys are obviously alot more proactive than our liver boys! We normally get suckered into dialysing the 'type 2 HRS' patients on the understanding that they'll be transplanted and get left holding the can when 8 weeks down the line, we're told they're not suitable for transplantation at all! Anyway-ammended edit to try and encompass the 'they'll die if they're not transplanted' angle. See what you think.Felix-felix 10:00, 24 July 2006 (UTC)
Looks good! An apt synopsis -- Samir धर्म 12:19, 24 July 2006 (UTC)

[edit] Good Article

This was definately clear, well-referenced, and approachable from someone like me, who doesn't know anything about the subject. Great work! Dlmccaslin 18:24, 11 August 2006 (UTC)

[edit] Hepatorenal failure

I haven't heard hepatorenal syndrome referred to as hepatorenal failure. eMedicine does not give hepatorenal failure as a synonym[1] nor does Stedman's medical dictionary.[2] Hepatorenal failure is not a precise term for the condition -- and the following ref. suggests it is not used, as hepatic and renal failure can occur simulateously for a number of different reasons. Davison AM. Hepatorenal failure. Nephrol Dial Transplant. 1996;11 Suppl 8:24-31. Review. PMID 9044337 Nephron  T|C 19:31, 9 September 2006 (UTC)

Agreed. Hepatorenal syndrome is a distinct definition -- Samir धर्म 01:28, 10 September 2006 (UTC)
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