Hepatorenal syndrome Health Article

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:

• Acute liver failure
• Alcoholic hepatitis
• Cirrhosis

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

Symptoms

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

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:

• Excess fluid in the abdomen (ascites)
• Hepatic encephalopathy
• Jaundice
• Other signs of liver failure

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:

• Absent or low urine production, less than 400 cc/day
• Fluid retention in the abdomen or extremities
• Increased BUN and creatinine levels
• Increased urine specific gravity and osmolality
• Low serum sodium
• Very low urine sodium concentration

The following may be signs of liver failure:

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