It is due to renal cortical vasoconstriction resulting from complex hemodynamic disturbances related to cirrhosis ABSTRACT and portal hypertension. There is no consistently effec-Patients with cirrhosis of the liver have increased hetive therapy except for liver transplantation. We report patic and gastrointestinal lymph flow that may contriba case of severe HRS in a patient with advanced liver ute to the formation of ascites and pleural effusions. Incirrhosis and portal hypertension. Three sessions of hecreased lymph flow, which is due to postsinusoidal modialysis were performed because of severe renal failportal hypertension, causes a high rate of flow through ure (serum urea 83 mg/dl, serum creatinine 6 mg/dl). Crethe thoracic duct. Because of the high flow rates, disation of an intrahepatic portosystemic shunt reduced rupted lymphatic vessels in patients with cirrhosis of the portocaval gradient from 18 to 7 mm Hg. Spectacular the liver may fail to close, a situation that results in improvement of the renal function was observed soon chylous ascites, pleural effusions, or chylous fistulas. after the procedure, with spontaneous recovery of diure-Chylous fistulas deplete proteins, fluid, and lymphocytes sis and a return of serum urea and creatinine to baseline and thus lead to volume depletion and coagulopathy. values. The patient unfortunately died 2 months later Herein we describe an unusual case in which a highfrom adult respiratory distress syndrome post emeroutput traumatic thoracic duct-cutaneous fistula gency surgery for a massive bleed related to a duodenal developed in a patient with cirrhosis and led to volume ulcer. Throughout this episode, the renal function redepletion and coagulopathy. Correction of the portal mained stable. The postmortem examination showed hypertension with placement of a transjugular intrahistologically normal kidneys. We conclude that the inhepatic portosystemic shunt led to closure of the fistrahepatic portosystemic shunt can improve renal functula and normalization of accompanying metabolic abtion in cirrhotic patients with HRS; it could be used in normalities.
patients awaiting liver transplantation to reverse preoperative renal failure.