الفهرس 
Introduction and Aim of the Work
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Abstract
The pathogenesis of hepatorenal syndrome HRS is not completely known but it is thought to be the extreme manifestation of the under filling of the arterial vasodilatation, located mainly in the splanchinic circulation. HRS is a serious complication in patients with cirrhosis and ascites and associated with poor prognosis unless liver transplantation can be performed .The aim of the present study is to assess the possible changes that occur in the levels of some biochemical and physiological parameters to be used as an index for prediction of hepatorenal syndrome (HRS) in cirrhotic patients. The study was conducted on 20 patients with C admitted to Mansoura University Hospital were included in this study. And 10 healthy individuals with no history of hepatic or renal disease, and with normal liver and kidney function tests five of them were male and five were female their age range was 3248 years. In Conclusion: The most important predictive factors of hepatorenal syndrome (HRS) in cirrhotic patients were the increase in, serum GGT, serum creatinine, urine/serum osmolarity ratio and serum K and the decrease in creatinine clearance, very low free water clearance, dilutional hyponatremia, hypoosmolarity and significant decrease in mean blood pressure. In addition increased Nitric oxide that marked vasodilatations in HRS patients may be due to over production of NO by the endothelium in splanchinic arterial walls which has specificity and sensitivity 100 % so has a high risk of developing HRS than the other parameters, Also a relative increase in serum and urinary cyclic AMP may be an early changes in HRS.