What is the definition of Hepatorenal Syndrome?

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.

What are the alternative names for Hepatorenal Syndrome?

Cirrhosis - hepatorenal; Liver failure - hepatorenal

What are the causes for Hepatorenal Syndrome?

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:

  • Acute liver failure
  • Alcoholic hepatitis
  • Cirrhosis
  • Infected abdominal fluid

Risk factors include:

  • Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)
  • Use of medicines called diuretics ("water pills")
  • Gastrointestinal bleeding
  • Infection
  • Recent abdominal fluid removal (paracentesis)

What are the symptoms for Hepatorenal Syndrome?

Symptoms include:

  • Abdominal swelling due to fluid (called ascites, a symptom of liver disease)
  • Mental confusion
  • Muscle jerks
  • Dark-colored urine (a symptom of liver disease)
  • Decreased urine output
  • Nausea and vomiting
  • Weight gain
  • Yellow skin (jaundice, a symptom of liver disease)

What are the current treatments for Hepatorenal Syndrome?

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:

  • Stopping all unnecessary medicines, especially ibuprofen and other NSAIDs, certain antibiotics, and diuretics ("water pills")
  • Having dialysis to improve symptoms
  • Taking medicines to improve blood pressure and help your kidneys work better; infusion of albumin may also be helpful
  • Placing a shunt (known as TIPS) to relieve the symptoms of ascites (this may also help kidney function, but the procedure can be risky)
  • Surgery to place a shunt from the abdominal space to the jugular vein to relieve some symptoms of kidney failure (this procedure is risky and is rarely done)

What is the outlook (prognosis) for Hepatorenal Syndrome?

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

What are the possible complications for Hepatorenal Syndrome?

Complications may include:

  • Bleeding
  • Damage to, and failure of, many organ systems
  • End-stage kidney disease
  • Fluid overload and heart failure
  • Coma caused by liver failure
  • Secondary infections

When should I contact a medical professional for Hepatorenal Syndrome?

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.

  • Condition: Type 1 Hepatorenal Syndrome
  • Journal: The New England journal of medicine
  • Treatment Used: Terlipressin plus Albumin
  • Number of Patients: 300
  • Published —
The study researched the use of Terlipressin plus Albumin for treating type 1 hepatorenal syndrome.
  • Condition: Children with Liver Disease
  • Journal: BMC nephrology
  • Treatment Used: Trerlipressin
  • Number of Patients: 16
  • Published —
This study determined the safety and effectiveness of terlipressin in the treatment of children with liver disease.
Clinical Trial
  • Status: Not yet recruiting
  • Phase: Phase 2
  • Intervention Type: Drug
  • Participants: 48
  • Start Date: July 1, 2021
Angiotensin 2 as a Novel Treatment for Hepatorenal Syndrome