Hepatorenal syndrome
Key points
- Hepatorenal syndrome is acute kidney failure occurring without other cause in a person with severe liver disease.
- Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder.
- A physical examination will not directly reveal kidney failure.
- Treatment is aimed at improving liver function and to ensuring that circulating blood volume and cardiac output (heart pumping action) are adequate.
Definition
Hepatorenal syndrome is acute kidney failure occurring without other cause in a person with severe liver disease.
Causes, incidence, and risk factors
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. The most common symptom is decreased urine production. As a result of reduced elimination of urine, nitrogen-containing waste products accumulate in the blood stream (azotemia).
The exact cause of hepatorenal syndrome is unknown. For some reason, there is drastic reduction in blood flow to the kidneys. The kidney structure remains essentially normal and the kidneys often will instantly function well if the liver disease is corrected (for example, by liver transplantation).
The disorder occurs in up to 10% of patients hospitalized with liver failure. It may be a sign of impending death caused by the accumulated effects of liver damage and kidney failure in people with acute liver failure, cirrhosis or alcoholic hepatitis. It is diagnosed when other causes of kidney failure are ruled out.
Risk factors include cirrhosis, alcoholic hepatitis, acute liver failure, recent abdominal paracentesis, infection, gastrointestinal bleeding, use of diuretics and the presence of orthostatic hypotension (blood pressure which falls when the person rises or suddenly changes position).
Symptoms
- Decreased urine production
- Dark-colored urine
- Yellow skin
- Weight gain
- Abdominal swelling
- Change in mental status
o Dementia
o Delirium
o Confusion - Coarse muscle movements, jerking
- Nausea and vomiting
Signs 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. Deep tendon reflexes are increased and abnormal reflexes may be present, indicating damage to the nervous system. The abdomen is 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 (spider telangiectasia) 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
Written and revised by
Gerald Hurowitz, M.D.
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