Portal login
Health Topics, Symptoms, In-Depth Reports

Hepatorenal syndrome

Cirrhosis - hepatorenal; Liver failure - hepatorenal; HRS

Hepatorenal syndrome is a condition in which there is progressive kidney failure that occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death.

Causes

Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is produced by the body, so waste products that contain nitrogen build up in the bloodstream (azotemia).

The disorder occurs in up to 1 in 10 people who are in the hospital with liver failure. It leads to kidney failure in people with:

Risk factors include:

  • Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)
  • Use of medicines called diuretics ("water pills")
  • Gastrointestinal bleeding
  • Infection
  • Recent abdominal fluid removal (paracentesis)
Symptoms

Symptoms include:

Exams and Tests

This condition is diagnosed after testing to check for other causes of kidney failure.

A physical exam does not detect kidney failure directly. However, the exam will very often show signs of chronic liver disease, such as:

  • Confusion (often due to hepatic encephalopathy)
  • Excess fluid in the abdomen (ascites)
  • Jaundice
  • Other signs of liver failure

Other signs include:

  • Abnormal reflexes
  • Smaller testicles
  • Dull sound in the belly area when tapped with the tips of the fingers
  • Increased breast tissue in men (gynecomastia)
  • Sores (lesions) on the skin

The following may be signs of kidney failure:

The following may be signs of liver failure:

Treatment

The goal of treatment is to help the liver work better and to make sure the heart is able to pump enough blood to the body.

Treatment is about the same as for kidney failure from any cause. It includes:

  • Stopping all unnecessary medicines, especially ibuprofen and other NSAIDs, certain antibiotics, and diuretics ("water pills")
  • Having dialysis to improve symptoms
  • Taking medicines to improve blood pressure and help your kidneys work better; infusion of albumin may also be helpful
  • Placing a shunt known as transjugular intrahepatic portosystemic shunt (TIPS) to relieve the symptoms of ascites (This may also help kidney function, but the procedure can be risky.)
  • Surgery to place a shunt from the abdominal space to the jugular vein to relieve some symptoms of kidney failure (This procedure is risky and is rarely done.)
Outlook (Prognosis)

The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).

Possible Complications

Complications may include:

When to Contact a Medical Professional

This disorder most often is diagnosed in the hospital during treatment for a liver disorder.

References

Fernandez J, Arroyo V. Hepatorenal syndrome. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 76.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 139.

Mehta SS, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and other systemic complications of liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 94.

Review Date: 6/11/2024

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
© 1997- adam.com All rights reserved.