Hepatorenal syndrome is a condition in which there is progressive kidney failure in a person with
Causes, incidence, and risk factors
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a severe liver disorder. Because less urine is removed from the body, nitrogen-containing waste products build up in the bloodstream (
The disorder occurs in up to 1 in 10 patients who are in the hospital due to liver failure. It leads to
Acute liver failure
Risk factors include:
Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)
Use of medicines called diuretics (“water pill”)
abdominal fluid tap(paracentesis)
Abdominal swellingdue to fluid (called ascites, a symptom of the underlying liver disease)
- Change in mental status
Coarse muscle movements or muscle jerks Dark-colored urine(a symptom of the underlying liver disease) Decreased urine production
- Nausea and vomiting
- Yellow skin (jaundice, a symptom of the underlying liver disease)
Signs and tests
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, including:
Confusion (often due to
Excess fluid in the abdomen (
Other signs of liver failure
Other signs include:
Dull sound in the belly area when tapped with the tips of the fingers
Increased breast tissue (gynecomastia)
Sores (lesions) on the skin
The following may be signs of kidney failure:
- Absent or low urine production, less than 400 cc/day
- Fluid retention in the abdomen or extremities
BUNand creatinineblood levels
urine specific gravityand osmolality
- Very low
The following may be signs of liver failure:
- Abnormal prothrombin time (
- Increased blood
blood albumin Paracentesisshows ascites
- Signs of
hepatic encephalopathy(an EEGmay be performed if such signs are present)
The goal of treatment is to help your liver work better and to make sure your heart is pumping enough blood to your body.
Treatment is generally the same as kidney failure due to any cause.
All unnecessary medicines should be stopped, especially ibuprofen and other NSAIDs, the antibiotic neomycin, and diuretics (“water pills”).
Dialysis may improve symptoms.
Medications such as octreotide plus midodrine, albumin, or dopamine may be used to improve blood pressure and temporarily to help your kidneys work better.
A nonsurgical shunt (known as TIPS) is used to relieve the symptoms of ascites and may help kidney function.
Surgery to place a
shunt(called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may also relieve some of the symptoms of kidney failure. Both procedures are risky and proper selection of patients is very important.
The predicted outcome is poor. Death is usually the result of a secondary infection or severe bleeding (hemorrhage).
- Damage to, and failure of, many organ systems
End-stage kidney disease
- Fluid overload with
congestive heart failureor pulmonary edema Hepatic coma
- Secondary infections
Calling your health care provider
This disorder most often is diagnosed in the hospital during treatment for a liver disorder.