Hepatorenal syndrome is a condition in which there is progressive kidney failure. It occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death.
Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is removed from the body, so waste products that contain nitrogen build up in the bloodstream (azotemia).
The disorder occurs in up to 1 in 10 patients who are in the hospital with liver failure. It leads to kidney failure in people with:
The goal of treatment is to help the liver work better and to make sure the heart is able to pump enough blood to the body.
Treatment is about the same as for kidney failure from any cause. It includes:
Stopping all unnecessary medicines, especially ibuprofen and other NSAIDs, the antibiotic neomycin or gentamicin, and diuretics ("water pills")
Having dialysis to improve symptoms
Taking medicines such as octreotide plus midodrine, albumin, norepinephrine, or dopamine to improve blood pressure and help your kidneys work better
Placing a nonsurgical shunt (known as TIPS) to relieve the symptoms of ascites (this may also help kidney function, but the procedure can be risky)
Surgery to place a shunt (called a peritoneovenous shunt) from the abdominal space (peritoneum) to the jugular vein to relieve some symptoms of kidney failure (this procedure is risky and is rarely done)
The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.