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Hepatorenal Syndrome

Development of functional renal failure in advanced liver disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Hepatorenal Syndrome?

Hepatorenal syndrome (HRS) is a condition that develops on a background of advanced cirrhosis and portal hypertension, with rapid deterioration of renal function despite the absence of structural kidney disease. Marked vasodilation in the splanchnic vascular bed, decreased effective arterial blood volume, and renal vasoconstriction form the basis of the mechanism.

HRS is common in cirrhotics with ascites and may emerge after triggering factors (spontaneous bacterial peritonitis, large-volume paracentesis, gastrointestinal bleeding, high-dose diuretics). Classically, two forms have been defined: Type 1 (acute, rapidly progressive) and Type 2 (slower course).

The terminology has been recently updated; it is classified as HRS-AKI (acute kidney injury type) and HRS-NAKI (chronic or non-acute).

Symptoms

Significant decrease in urine volume (oliguria/anuria)
Very low urinary sodium (<10 mEq/L)
Worsening ascites and peripheral edema
Nausea, vomiting, and loss of appetite
Confusion and hepatic encephalopathy
Hypotension and tachycardia
Weight gain (due to fluid retention)

Risk Factors

Advanced cirrhosis and portal hypertension
Presence of ascites and hypoalbuminemia
Spontaneous bacterial peritonitis
Gastrointestinal bleeding
Large-volume paracentesis (without albumin replacement)
Use of nephrotoxic drugs and NSAIDs
Excessive diuretic use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If urine volume decreases in a patient with cirrhosis
  • If blood creatinine value rises rapidly
  • If ascites worsens rapidly and does not respond to treatment
  • If confusion and muscle twitching are added
  • If renal deterioration occurs with fever or abdominal pain (urgent)

Treatment Methods

01
Terlipressin + albumin infusion (first-line vasoconstrictor therapy)
02
Norepinephrine + albumin (alternative in intensive care setting)
03
Discontinuation of nephrotoxic drugs and reduction of diuretic dose
04
Treatment of precipitating factors (infection, bleeding)
05
Transjugular intrahepatic portosystemic shunt (TIPS) in refractory cases
06
Liver transplantation (only curative option)

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.