Liver Metastasis: An Unsung Etiology of Hepatorenal Syndrome

Hepatorenal syndrome is a reversible acute kidney injury affecting patients with acute liver failure, cirrhosis or acute on chronic liver failure. The tsunami of metastatic liver disease and their various presentations has always intrigued the clinicians. Liver metastasis attributing to hepatorenal syndrome in otherwise normal liver parenchyma is a less considered and often an ignored etiology. Secondly less aggressive treatment approach of such patients has also shielded its presence. We present a case of pancreatic malignancy with liver metastasis who had Icterus, ascites, coagulopathy and altered sensorium. In due course of stay in the hospital patient's urine output reduced and serum creatinine got elevated. Diagnosis of hepatorenal syndrome was made and treatment was initiated. Outcome of such patients on a large scale could provide a better picture for their prognosis and at the same time empower efforts of clinicians.