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Definition:

Hepatorenal syndrome is a condition in which the kidneys fail suddenly in a person with cirrhosis of the liver. It is a serious complication of cirrhosis.



Causes, incidence, and risk factors:

Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. Because less urine is removed from the body, nitrogen-containing waste products build up in the bloodstream (azotemia ).

The disorder occurs in up to 10% of patients hospitalized with liver failure. It is caused by the built-up effects of liver damage and kidney failure in people with:

Other risk factors include:

  • Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)
  • Diuretic use
  • Gastrointestinal bleeding
  • Infection
  • Recent abdominal paracentesis


Signs and tests:

This condition is diagnosed when other causes of kidney failure are ruled out.

A physical examination will not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease:

Other signs include:

  • Abnormal reflexes
  • Decreased testicle size
  • Dull sound in the abdomen when tapped with the tips of the fingers, and visible fluid wave when examined by feel
  • Increased breast tissue
  • Sores (lesions) on the skin

The following may be signs of kidney failure:

The following may be signs of liver failure:



Treatment:

Treatment aims to improve liver function and ensure that there is enough blood in the body and the heart is pumping adequately.

The disorder is generally treated in the same way as kidney failure from any other cause.

  • All unnecessary medicines are stopped, especially the antibiotic neomycin, ibuprofen and other NSAIDs, and diuretics ("water pills").
  • Dialysis may improve symptoms.
  • Medications such as octreotide, albumin, and dopamine may be used temporarily to improve kidney function.
  • Surgery to place a shunt (called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may relieve some of the symptoms of kidney failure. However, surgical shunts are rarely placed, because severe liver disease makes surgery very risky. A nonsurgical shunt (known as TIPS) may be tried in some patients.


Support Groups:



Expectations (prognosis):

The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.



Complications:

Calling your health care provider:

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



Prevention:



References:

Cárdenas A, Gines P. Hepatorenal syndrome. Clin Liver Dis. 2006;10:371-385.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.




Review Date: 5/20/2008
Reviewed By: Christian Stone, MD, Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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