Hepatorenal syndrome (HRS) is a type of progressive kidney failure seen in people with severe liver damage, most often caused by cirrhosis. As the kidneys stop functioning, toxins begin to build up in the body. Eventually, this leads to liver failure.
There are two forms of HRS. Type 1 HRS is associated with rapid kidney failure and an overproduction of creatinine. Type 2 HRS is associated with more gradual kidney damage. It generally progresses more slowly. Symptoms are generally subtler.
HRS is an extremely serious condition. It’s almost always fatal. According to a study in Clinical Biochemist Reviews, people with type 1 HRS have a median survival time of two weeks. Almost everyone with type 1 will die within eight to 10 weeks, unless a liver transplant can be performed urgently. The median survival time for type 2 is six months.
Symptoms of HRS should be treated as a medical emergency. If you experience any of the symptoms listed below, contact your doctor immediately. Treatment is particularly urgent if you’re currently being treated for other kidney problems.
Common symptoms of HRS include:
Causes and Risk Factors
HRS is always a complication of liver disease. The condition is almost always caused by cirrhosis of the liver. If you have cirrhosis, certain factors increase your risk of HRS. These include:
- unstable blood pressure
- use of diuretics
- acute alcoholic hepatitis
- gastrointestinal bleeding
- spontaneous bacterial peritonitis
- other infections (especially in the kidneys)
Your doctor may first suspect you have this condition during a physical examination. They will look for signs of HRS such as:
- swollen breast tissue
- sores on the skin
- fluid buildup in the abdomen
Diagnosing HRS means excluding other causes of kidney failure. This requires a series of blood and urine tests. The tests will help your doctor evaluate your liver and kidney function. In rare cases, HRS can occur in patients whose liver has been damaged by other causes than cirrhosis. If you don’t have cirrhosis, your doctor may order additional tests for viral or alcoholic hepatitis.
Medications called vasoconstrictors can help with the low blood pressure caused by HRS. Dialysis may be used to improve kidney symptoms. Dialysis filters harmful wastes, excess salt, and excess water from your blood. It’s performed in a hospital or dialysis clinic. Liver transplants are the most effective treatment for HRS. The waiting list for a liver transplant is long and many people die before a liver is available. If you can get a transplant, your chance of survival improves greatly.
Outlook and Complications
HRS is almost always fatal. However, a liver transplant can extend your life. Complications of HRS normally appear during end-stage kidney disease. They include:
- fluid overload
- secondary infections
- organ damage
The only certain way to prevent HRS is to keep your liver healthy. To reduce your risk of developing cirrhosis, avoid drinking excessive amounts of alcohol.
You should also try to avoid contracting hepatitis. Hepatitis A and B can be prevented by vaccination. There’s currently no vaccine against hepatitis C. Some measures you can take to prevent hepatitis C include:
- washing your hands after shaking hands
- having your sex partner get tested for hepatitis C
- not sharing needles with anyone
- not using illegal drugs
- consistently practicing safe sex
Some causes of cirrhosis can’t be prevented. If you’re at risk for developing cirrhosis, your doctor may monitor your liver function regularly. They may also order blood and imaging tests to detect early signs of the condition.