Hepatorenal Syndrome

Written by April Kahn | Published on June 30, 2012
Medically Reviewed by George Krucik, MD

What Is Hepatorenal Syndrome?

Hepatorenal syndrome (HRS) is a type of progressive kidney failure. As the kidneys stop functioning, toxins begin to build up in the body. Eventually, this leads to liver failure. It is only seen in people with severe liver damage and is almost always caused by cirrhosis. There are two forms of HRS. Type 1 HRS is associated with rapid kidney failure. There is also 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 is almost always fatal. According to an article in Clinical Biochemist Reviews, people with type 1 HRS have a median survival time of two weeks. Almost everyone with this type of the disease will die within eight to 10 weeks. The median survival time for type 2 is six months. (Ng, etal., 2007).

Causes of and Risk Factors for Hepatorenal Syndrome

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 HRS. These include:

  • unstable blood pressure
  • using diuretics
  • gastrointestinal bleeding
  • spontaneous bacterial peritonitis
  • other infections (especially in the kidneys)

What Are the Symptoms of Hepatorenal Syndrome?

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 are currently being treated for other kidney problems.

Common symptoms of HRS include:

  • confusion
  • delirium
  • nausea
  • vomiting
  • dementia
  • weight gain
  • jaundice (yellowing of skin and eyes)
  • decreased urine output
  • dark-colored urine
  • swollen abdomen

Diagnosing Hepatorenal Syndrome

This condition may first be suspected during a physical examination. Your doctor will look for signs of HRS such as:

  • swollen breast tissue
  • sores on the skin
  • fluid buildup in the abdomen. This causes a dull sound when the abdomen is being tapped.

However, diagnosing HRS means excluding other causes of kidney failure. This will require a series of blood and urine tests. The tests will 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 do not have cirrhosis, your doctor may want to find out what is causing your liver damage. This may require tests for viral or alcoholic hepatitis.

Treatment of Hepatorenal Syndrome

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 is performed in a hospital or dialysis clinic. Liver transplants are the most effective treatment for HRS. However, the waiting list for a liver transplant is long and many patients die before a liver is available. If a transplant can be performed, survival is greatly improved.

Complications and Long-Term Outlook for Hepatorenal Syndrome

HRS is almost uniformly fatal. However, a liver transplant can extend the life of some patients. Complications of HRS normally appear during end-stage kidney disease. They include:

  • fluid overload
  • secondary infections
  • organ failure
  • organ damage
  • coma

Preventing Hepatorenal Syndrome

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. However, there is 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 cannot be prevented. If you are at risk for developing cirrhosis, your doctor may monitor your liver function regularly. Blood and imaging tests may be able to detect early signs of the condition.

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Article Sources:

  • Cárdenas, A. (2005) Hepatorenal Syndrome: A Dreaded Complication of End -Stage Liver Disease. American Journal of Gastroenterology. 100:460-7. Retrieved June 21, 2012, from http://medres.med.ucla.edu/Education/syllabus/Nephrology/pdf/Hepatorenal%20Synd%20-%20compl%20of%20liver%20disease.pdf
  • Gines, P., Guevara, M., Arroyo, V., Rodés, J. (2003) Hepatorenal Syndrome. (Lancet. 362:1819-27. Retrieved June 21, 2012, from http://www.uphs.upenn.edu/renal/important%20pdf/hepatorenal%20syndrome.pdf
  • Ng, C.K.F., Chan, M.H.M., Tai, M.H.L., & Lam, C.W.K. (2007, February 28). Hepatorenal Syndrome. The Clinical Biochemist Reviews. 28(1): 11-17. Retrieved June 21, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904420/

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