Hepatorenal syndrome

Definition

Hepatorenal syndrome is acute kidney failure that occurs with no cause in a person with severe liver disease.

Causes

Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. The most common symptom is decreased urine production. As a result of reduced elimination of urine, nitrogen-containing waste products accumulate in the blood stream (azotemia).

The exact cause of hepatorenal syndrome is unknown. For some reason, there is severe reduction in blood flow to the kidneys. The structure of the kidney remains basically normal, and the kidneys will often function instantly well if the liver disease is corrected (for example, by liver transplantation).

The disorder occurs in up to 10% of patients hospitalized with liver failure. It may be a sign of approaching death, caused by the accumulated effects of liver damage and kidney failure, in people with acute liver failure, cirrhosis, or alcoholic hepatitis. It is diagnosed when other causes of kidney failure are ruled out.

Risk factors include cirrhosis, alcoholic hepatitis, acute liver failure, recent abdominal paracentesis, infection, gastrointestinal bleeding, use of diuretics, and the presence of orthostatic hypotension (blood pressure which falls when the person rises or suddenly changes position).