Hepatorenal SyndromeSymptoms, Doctors, Treatments, Advances & More
Learn About 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.
Cirrhosis - hepatorenal; Liver failure - hepatorenal; HRS; Hepatorenal syndrome - acute kidney injury; Hepatorenal syndrome AKI; Hepatorenal syndrome - non acute kidney injury; Hepatorenal syndrome – NAKI; Hepatorenal syndrome - Type 1; Hepatorenal syndrome - Type 2
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
- 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
- Taking medicines to improve blood pressure and help your kidneys work better. This may include intravenous medicines such as norepinephrine (usually requires being in an intensive care unit).
- Infusion of albumin.
- Terlipressin which works best when combined with an albumin infusion.
- Having dialysis to improve symptoms.
- 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.)
Pere Gines practices practicing medicine in Barcelona, Spain. Mr. Gines is rated as an Elite expert by MediFind in the treatment of Hepatorenal Syndrome. He is also highly rated in 18 other conditions, according to our data. His clinical expertise encompasses Hepatorenal Syndrome, Liver Failure, Cirrhosis, Ascites, and Liver Transplant.
AZ - Transplant GI
Hugo Vargas is a Gastroenterologist practicing medicine in Phoenix, Arizona. Dr. Vargas is rated as an Elite provider by MediFind in the treatment of Hepatorenal Syndrome. He is also highly rated in 15 other conditions, according to our data. His clinical expertise encompasses Hepatorenal Syndrome, Liver Failure, Hepatitis, Liver Transplant, and Colonoscopy.
Medical Procedures Unit
Pratima Sharma is a Gastroenterologist and a Transplant Surgeon practicing medicine in Brighton, Michigan. Dr. Sharma is rated as an Elite provider by MediFind in the treatment of Hepatorenal Syndrome. She is also highly rated in 23 other conditions, according to our data. Her clinical expertise encompasses Hepatorenal Syndrome, Liver Failure, Hepatitis, Liver Transplant, and Kidney Transplant. Dr. Sharma is board certified in Transplant Hepatology and Gastroenterology. Dr. Sharma is currently accepting new patients.
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.
Summary: Cirrhosis, a leading cause of global mortality, progresses to life-threatening complications like ascites, hepatic encephalopathy, and hepatorenal syndrome. Oxidative stress and gut-liver axis dysfunction drive disease progression. Allopurinol, a xanthine oxidase inhibitor, has shown potential in reducing complications in cirrhosis, but robust clinical evidence is lacking. This study will evaluate...
Summary: Hepato-renal fibrocystic diseases (HRFD) is a term developed that encompasses rare diseases such as Autosomal Recessive Polycystic Kidney Disease (ARPKD), and other diseases with common features (Joubert syndrome, Bardet Biedl syndrome, Meckel-Gruber syndrome, congenital hepatic fibrosis (CHF), Caroli syndrome (CS), polycystic liver disease, oro-facial-digital syndrome, nephronophithisis (NPHP), a...
Published Date: April 27, 2026
Published By: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. 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.
Bommena S, Nathani R, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and other systemic complications of liver disease. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 96.
Fernandez J, Arroyo V. Hepatorenal syndrome. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 76.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 139.