Cirrhosis - hepatorenal; Liver failure - hepatorenal
Hepatorenal syndrome is a condition in which there is progressive kidney failure that occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death.
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:
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:
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:
The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).
Complications may include:
This disorder most often is diagnosed in the hospital during treatment for a liver disorder.
Fernandez J, Arroyo V. Hepatorenal syndrome. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 73.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.
Mehta SS, 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. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 94.BACK TO TOP
Review Date: 3/31/2020
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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