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.

Cirrhosis - hepatorenal; Liver failure - hepatorenal; HRS

Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is produced by 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 (peritonitis)

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)

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)

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 transjugular intrahepatic portosystemic shunt (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.)

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

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

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

Published Date: June 11, 2024
Published By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 139.

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.