A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this?
A. Oliguria and azotemia
B. Metabolic alkalosis
C. Decreased urinary concentration
D. Weight gain of less than 1 lb per week
Correct Answer: A. Oliguria and azotemia
Hepatorenal syndrome is a functional disorder resulting from a redistribution of renal blood flow. Oliguria and azotemia occur abruptly as a result of this complication. Confusion due to hepatic encephalopathy is likely the last and most severe stage of liver disease as a result of the liver failing to break down toxic metabolites. Most importantly these patients notice they urinate less frequently in smaller and smaller volumes as they become oliguric.
Option B: Excess organic acids are not being excreted by the damaged kidneys, resulting in an elevated concentration of hydrogen ions; decreased pH occurs, causing metabolic acidosis. Cirrhosis and portal hypertension can trigger the neurohormonal cascade which leads to the development of HRS. This, in turn, causes the production and release of vasodilators and cytokines like nitric oxide and prostaglandins which cause splanchnic and systemic vasodilation.
Option C: Concentration of the urine is increased with decreased renal function. The systemic drop in circulating pressure triggers the carotid and aortic arch baroreceptors to activate three separate compensatory mechanisms. These include the renin-angiotensin-aldosterone system, vasopressin release, and activation of the sympathetic nervous system (SNS).
Option D: With renal insufficiency, significant weight gain is expected due to fluid retention. The progression of cirrhosis causes a fall in cardiac output and a fall in systemic vascular resistance in a cycle that induces further renal vasoconstriction. This leads to further renal hypoperfusion, worsened by renal vasoconstriction with the endpoint of renal failure.
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