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Hepatorenal Syndrome (Type 1 and Type 2)

Functional renal insufficiency due to advanced liver failure.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

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What is Hepatorenal Syndrome (Type 1 and Type 2)?

Hepatorenal syndrome (HRS) is a syndrome characterized by progressive loss of kidney function without structural kidney damage in decompensated cirrhosis or acute liver failure. The kidneys are histologically normal and may regain function after transplantation.

HRS-AKI (formerly Type 1) is the rapidly progressive form, in which serum creatinine reaches double the baseline or greater than 2.5 mg/dL within two weeks. HRS-NAKI (formerly Type 2) is slower in course and is associated with refractory ascites.

The main pathogenetic mechanisms include splanchnic arterial vasodilation due to portal hypertension, reduction of effective circulating volume, and compensatory renal vasoconstriction.

Symptoms

Oliguria (markedly reduced urine output)
Increased ascites (diuretic-refractory)
Hypotension and tachycardia
Worsening jaundice
Hyponatremia (serum sodium less than 130 mEq/L)

Risk Factors

Spontaneous bacterial peritonitis (SBP) — the most important trigger
Large-volume paracentesis (without albumin replacement)
Gastrointestinal bleeding
Aggressive use of diuretics
MELD score greater than 18

When to See a Doctor?

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

  • If urine output is markedly decreased in a cirrhotic patient — EMERGENCY
  • If serum creatinine is rising rapidly
  • If refractory ascites and worsening kidney function are both present
  • If kidney function deteriorates after SBP

Treatment Methods

01
HRS-AKI: Terlipressin + albumin (first-line therapy)
02
Norepinephrine + albumin (if terlipressin is unavailable — in ICU setting)
03
Midodrine + octreotide + albumin (alternative combination therapy)
04
TIPS (transjugular intrahepatic portosystemic shunt — in selected cases)
05
Liver transplantation (definitive treatment)
06
Renal replacement therapy (as a bridge)

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.

Learn About Dahiliye (İç Hastalıkları) Department

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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.