Hepatorenal syndrome is a condition in which there is progressive kidney failure in a person with cirrhosis of the liver. It is a serious and often life-threatening complication of cirrhosis.
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. Because less urine is removed from the body, nitrogen-containing waste products build up in the bloodstream (azotemia).
The disorder occurs in up to 10% of patients hospitalized with liver failure. It is caused by the mounting effects of liver damage and leads to kidney failure in people with:
Risk factors include:
This condition is diagnosed when other causes of kidney failure are ruled out by the appropriate tests.
A physical examination does not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease:
Other signs include:
The following may be signs of kidney failure:
The following may be signs of liver failure:
Treatment aims to improve liver function and ensure that there is enough blood volume in the body and that the heart is pumping it adequately.
The disorder is generally treated in the same way as kidney failure from any other cause.
The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.
This disorder most often is diagnosed in the hospital during treatment for a liver disorder.
Garcia-Tsao G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 157.
Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.
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