Gait failure

Gait failure is a common presentation in the Emergency Department, and one that may herald an acute neurologic episode. This article reviews the mechanisms of gait failure, some of their causes, and the appropriate examination techniques for determining possible diagnoses.     

Hepatorenal failure

Renal failure in patients with liver disease is a common finding and may arise by a number of different mechanisms. However, in patients with cirrhosis or fulminant hepatic failure renal failure is often said to be functional. The urinary sodium concentration is low and the urine osmolality often high. This syndrome is also called hepatorenal failure. Recent studies, however, have indicated a range of renal function from functional at one end to acute tubular necrosis at the other. Functional renal failure seems to have a circulatory basis within the kidney holding out hope that, in theory at least, it might be possible to reverse it by pharmacological manipulation. In the meantime, a trial of dialysis in a series of patients with liver disease who developed renal failure has shown that if improvement of liver function can be expected, or if there is a clear precipitating cause for renal failure, then treatment of renal failure should be vigorous and expectant.