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Hepatorenal syndrome

Cirrhosis - hepatorenal; Liver failure - hepatorenal

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 rule out 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 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.

Open References

References

Fernandez J, Arroyo V. Hepatorenal syndrome. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 73.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.

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: 5/4/2022

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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