Hepatorenal syndrome is a condition in which there is progressive kidney failure in a person with cirrhosis of the liver. It is a serious and often life-threatening complication of cirrhosis.
Causes, incidence, and risk factors
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a severe 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 1 in 10 patients who are in the hospital due to liver failure. It leads to kidney failure in people with:
The goal of treatment is to help your liver work better and to make sure your heart is pumping enough blood to your body.
Treatment is generally the same as kidney failure due to any cause.
All unnecessary medicines should be stopped, especially ibuprofen and other NSAIDs, the antibiotic neomycin, and diuretics ("water pills").
Dialysis may improve symptoms.
Medications such as octreotide plus midodrine, albumin, or dopamine may be used to improve blood pressure and temporarily to help your kidneys work better.
A nonsurgical shunt (known as TIPS) is used to relieve the symptoms of ascites and may help kidney function.
Surgery to place a shunt (called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may also relieve some of the symptoms of kidney failure. Both procedures are risky and proper selection of patients is very important.
The predicted outcome is poor. Death is usually the result of a secondary infection or severe bleeding (hemorrhage).
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.