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Hepatorenal syndrome

Cirrhosis - hepatorenal; Liver failure - hepatorenal

Hepatorenal syndrome is a condition in which there is progressive kidney failure. It occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death.

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Causes

Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is removed from the body, so waste products that contain nitrogen build up in the bloodstream (azotemia).

The disorder occurs in up to 1 in 10 people who are in the hospital with liver failure. It leads to kidney failure in people with:

Risk factors include:

Symptoms

Symptoms include:

Exams and Tests

This condition is diagnosed after testing to rule out other causes of kidney failure.

A physical exam does not detect kidney failure directly. However, the exam will very often show signs of chronic liver disease, such as:

Other signs include:

The following may be signs of kidney failure:

The following may be signs of liver failure:

Treatment

The goal of treatment is to help the liver work better and to make sure the heart is able to pump enough blood to the body.

Treatment is about the same as for kidney failure from any cause. It includes:

Outlook (Prognosis)

The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).

Possible Complications

Complications may include:

When to Contact a Medical Professional

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

Related Information

Urine output - decreased
Prerenal azotemia
Liver disease
Acute kidney failure
Cirrhosis
Hepatitis
Abdominal tap
Loss of brain function - liver disease
End-stage kidney disease
Heart failure - overview
Pulmonary edema

References

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

Nevah MI, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and other systemic complications of liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 94.

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Review Date: 4/7/2018  

Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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