Hepatorenal syndrome

Symptoms

• Decreased urine production
• Dark-colored urine
• Yellow skin
• Weight gain  
• Abdominal swelling
• Change in mental status
  • Dementia
  • Delirium
  • Confusion
• Coarse muscle movements, jerking
• Nausea and vomiting

Exams and Tests

A physical examination will not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease -- hepatic encephalopathy, jaundice, ascites, and other signs of liver failure. Abnormal reflexes may be present, indicating damage to the nervous system. The abdomen sounds dull when tapped with the tips of the fingers, and often has a visible fluid wave when examined by feel. There may be increased breast tissue, decreased testicular size, lesions on the skin, or other signs of liver failure.

The following may indicate kidney failure:

• Absent or low urine production, less than 400 cc/day
• Very low urine sodium concentration
• Increased urine specific gravity and osmolality
• Low serum sodium
• Fluid retention in the abdomen or extremities
• Increased BUN and creatinine levels (in people with liver disease, the BUN and creatinine levels underestimate the severity of kidney dysfunction)

The following may indicate liver failure:

• Low serum albumin
• Abnormal PT
• Increased ammonia levels
• Paracentesis with ascites
• Signs of hepatic encephalopathy (an EEG may be performed if such signs are present)