Table of ContentsView AllTable of ContentsDefinition of Hepatorenal Syndrome (HRS)Risk FactorsDisease ProgressionDiagnosisTypesPrevention
Table of ContentsView All
View All
Table of Contents
Definition of Hepatorenal Syndrome (HRS)
Risk Factors
Disease Progression
Diagnosis
Types
Prevention
Human organs don’t execute their responsibilities in isolation. They communicate with each other. They depend on each other. Understanding an organ’s function requires one to understand the role of the other organs as well.
The human body is like a really complicated orchestra. If you were to just listen to individual musicians, you might not appreciate the symphony. Once we understand this important concept, it becomes easier to appreciate that problems with one organ’s function could adversely affect another.
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Definition of Hepatorenal Syndrome (HRS)
As the term suggests, the word “hepato” pertains to the liver, while “renal” refers to the kidney. Hence, hepatorenal syndrome implies a condition where liver disease leads to kidney disease or in extreme cases, complete kidney failure.
But, why do we need to know about hepatorenal syndrome? Liver disease is a fairly common entity (thinkhepatitis BorC). And in the universe of liver disease, hepatorenal syndrome is not an uncommon condition. In fact, according to one statistic, 40 percent of patients with cirrhosis (scarred, shrunken liver) and ascites (fluid accumulation in the stomach in advancedliver disease) will develop hepatorenal syndrome within five years.
The initiating factor in hepatorenal syndrome is always some kind of liver disease. This could be everything ranging from hepatitis B or C, drugs,autoimmune disease, liver tumors, andcirrhosis. Hepatorenal syndrome can also result infulminant liver failure. All of these conditions can induce kidney disease and kidney failure of varying levels of severity in the hepatorenal patient.
However, there are some identified risk factors that significantly increase the chances of having kidney failure because of liver disease.
Water pills (diuretics like furosemide or spironolactone) that are given to patients with cirrhosis and fluid overload do not precipitate hepatorenal syndrome (although they can hurt the kidneys in other ways).
One main factor determining blood supply to any organ is the resistance encountered during its flow to the organ. Based on the laws of physics, the narrower a blood vessel, the higher the resistance in the blood flow.
Similarly, in the case of hepatorenal syndrome, widening (dilatation) of certain blood vessels in the abdominal splanchnic circulation diverts blood away from the kidneys (whose blood vessels get constricted). Although this does not necessarily proceed in distinct linear steps, for the sake of understanding, here is how we could map this out:
These blood flow alterations then culminate and produce a relatively rapid decline in the kidney function.
Even diagnosing kidney failure might not always be straightforward in the patient with advanced liver disease or cirrhosis. This is because the most common test that we depend on to assess kidney function, the serum creatinine level, might not elevate too much in cirrhosis patients in the first place. Therefore, just looking at a serum creatinine level could mislead the diagnostician since it will lead to underestimation of the severity of kidney failure. Therefore, other tests like 24-hour urine creatinine clearance might be necessary to support or refute the level of kidney failure.
Once the diagnosis is confirmed using the above criteria, physicians will classify hepatorenal syndrome into Type-I or Type-II. The difference lies in the severity and the course of the illness. Type I is the more severe kind, associated with a rapid and profound decline in kidney function.
Treatment
Finally, there is the factor of time. Especially in Type-I HRS. Hence, while the liver disease might be treatable, it may not be possible to wait for its treatment in a patient with rapidly failing kidneys. In that case, medications anddialysis become necessary. Here are a few choices that we have:
Typically, if medications described above do not work within two weeks, treatment might be considered futile and the risk of death goes up drastically.
It depends. If the patient has a known liver disease with complications that are recognized precipitants (as described above in the section on high-risk patients) of hepatorenal syndrome, certain preventive therapies might work. For instance, patients with cirrhosis and fluid in the abdomen (called ascites), might benefit from an antibiotic called norfloxacin. Patients might benefit from intravenous repletion of albumin as well.
1 SourceVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Erly B, Carey W, Kapoor B, McKinney J, Tam M, Wang W.Hepatorenal syndrome: a review of pathophysiology and current treatment options.Seminars in Interventional Radiology. 2015;32(04):445-454. doi. 10.1055/s-0035-1564794. Published December, 2015.Additional ReadingTerlipressin in hepatorenal syndrome: Evidence for present indications. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:109-14. doi: 10.1111/j.1440-1746.2010.06583.xPrimary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Fernández J. Gastroenterology. 2007 Sep;133(3):818-24. Epub 2007 Jul 3.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gines et al. Gastroenterology. 1993 Jul;105(1):229-36.
1 Source
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Erly B, Carey W, Kapoor B, McKinney J, Tam M, Wang W.Hepatorenal syndrome: a review of pathophysiology and current treatment options.Seminars in Interventional Radiology. 2015;32(04):445-454. doi. 10.1055/s-0035-1564794. Published December, 2015.Additional ReadingTerlipressin in hepatorenal syndrome: Evidence for present indications. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:109-14. doi: 10.1111/j.1440-1746.2010.06583.xPrimary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Fernández J. Gastroenterology. 2007 Sep;133(3):818-24. Epub 2007 Jul 3.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gines et al. Gastroenterology. 1993 Jul;105(1):229-36.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Erly B, Carey W, Kapoor B, McKinney J, Tam M, Wang W.Hepatorenal syndrome: a review of pathophysiology and current treatment options.Seminars in Interventional Radiology. 2015;32(04):445-454. doi. 10.1055/s-0035-1564794. Published December, 2015.
Terlipressin in hepatorenal syndrome: Evidence for present indications. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:109-14. doi: 10.1111/j.1440-1746.2010.06583.xPrimary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Fernández J. Gastroenterology. 2007 Sep;133(3):818-24. Epub 2007 Jul 3.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gines et al. Gastroenterology. 1993 Jul;105(1):229-36.
Terlipressin in hepatorenal syndrome: Evidence for present indications. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:109-14. doi: 10.1111/j.1440-1746.2010.06583.x
Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Fernández J. Gastroenterology. 2007 Sep;133(3):818-24. Epub 2007 Jul 3.
Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gines et al. Gastroenterology. 1993 Jul;105(1):229-36.
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