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Hepatorenal syndrome

• Overview
• Symptoms
• Treatment

Treatment:

Treatment is aimed at improving liver function, and ensuring that the amount of blood in the body and the heart pumping action are adequate. The disorder is generally treated in the same manner as kidney failure from any other cause. All unnecessary medicines are stopped. This is especially true for the antibiotic neomycin, NSAIDS (pain relievers such as ibuprofen)  and diuretics ("water pills"). Dialysis may improve symptoms. There are medications such as octreotide, albumin, and dopamine, which may be used as a temporary measure to improve kidney function.

Surgical placement of a shunt (called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may reduce ascites and reverse some of the symptoms of kidney failure. However, surgical shunts are rarely placed, because severe liver disease makes surgery very risky. A non-surgical shunt (known as TIPS) may be tried in some patients.

Expectations (prognosis):

The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.

Complications:

• Secondary infections
• Bleeding
• Hepatic coma
• End-stage kidney disease
• Fluid overload with subsequent congestive heart failure or pulmonary edema
• Damage and failure of multiple organ systems

Calling your health care provider:

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

• Review Date: 5/4/2006
• Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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