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</div><div><span>Hepatorenal syndrome</span></div></div>
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</a><h1 class="with-also" itemprop="name">Hepatorenal syndrome</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Hepatorenal syndrome is a condition in which there is progressive kidney failure that occurs in a person with <a test="test" href="./000255.htm">cirrhosis</a> of the liver. It is a serious complication that can lead to death. </p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is produced by the body, so waste products that contain nitrogen build up in the bloodstream (<a test="test" href="./000508.htm">azotemia</a>).</p><p>The disorder occurs in up to 1 in 10 people who are in the hospital with liver failure. It leads to <a test="test" href="./000501.htm">kidney failure</a> in people with:</p><ul><li>Acute liver failure</li><li>Alcoholic <a test="test" href="./001154.htm">hepatitis</a></li><li><a test="test" href="./000255.htm">Cirrhosis</a></li><li><a test="test" href="./000648.htm">Infected abdominal fluid</a> (peritonitis)</li></ul><p>Risk factors include:</p><ul><li>Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)</li><li>Use of medicines called diuretics ("water pills")</li><li>Gastrointestinal bleeding</li><li>Infection</li><li>Recent <a test="test" href="./003896.htm">abdominal fluid removal</a> (paracentesis) </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms include:</p><ul><li><a test="test" href="./000286.htm">Abdominal swelling due to fluid</a> (called ascites, a symptom of liver disease)</li><li>Mental <a test="test" href="./003205.htm">confusion</a></li><li>Muscle jerks</li><li><a test="test" href="./003139.htm">Dark-colored urine</a> (a symptom of liver disease)</li><li><a test="test" href="./003147.htm">Decreased urine output</a></li><li>Nausea and vomiting</li><li><a test="test" href="./003084.htm">Weight gain</a></li><li>Yellow skin (jaundice, a symptom of liver disease) </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>This condition is diagnosed after testing to check for other causes of kidney failure. </p><p>A physical exam does not detect kidney failure directly. However, the exam will very often show signs of chronic liver disease, such as:</p><ul><li>Confusion (often due to <a test="test" href="./000302.htm">hepatic encephalopathy</a>)</li><li>Excess fluid in the abdomen (ascites)</li><li>Jaundice</li><li>Other signs of liver failure </li></ul><p>Other signs include:</p><ul><li>Abnormal reflexes</li><li>Smaller testicles</li><li>Dull sound in the belly area when tapped with the tips of the fingers</li><li>Increased breast tissue in men (gynecomastia)</li><li>Sores (lesions) on the skin </li></ul><p>The following may be signs of kidney failure:</p><ul><li>Very little or no urine output</li><li>Fluid retention in the abdomen or extremities</li><li>Increased <a test="test" href="./003474.htm">BUN</a> and <a test="test" href="./003475.htm">creatinine</a> blood levels</li><li>Increased <a test="test" href="./003587.htm">urine specific gravity</a> and <a test="test" href="./003463.htm">osmolality</a></li><li>Low <a test="test" href="./003481.htm">blood sodium</a></li><li>Very low <a test="test" href="./003599.htm">urine sodium</a> concentration </li></ul><p>The following may be signs of liver failure:</p><ul><li>Abnormal <a test="test" href="./003652.htm">prothrombin time</a> (PT)</li><li>Increased blood <a test="test" href="./002759.htm">ammonia</a> level</li><li>Low <a test="test" href="./003480.htm">blood albumin</a></li><li>Abdominal ultrasound shows ascites</li><li>Signs of <a test="test" href="./000302.htm">hepatic encephalopathy</a> (an <a test="test" href="./003931.htm">EEG</a> may be done to diagnose this condition) </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>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. </p><p>Treatment is about the same as for kidney failure from any cause. It includes:</p><ul><li>Stopping all unnecessary medicines, especially ibuprofen and other NSAIDs, certain antibiotics, and diuretics ("water pills")</li><li>Having dialysis to improve symptoms</li><li>Taking medicines to improve blood pressure and help your kidneys work better; infusion of albumin may also be helpful</li><li>Placing a shunt known as transjugular intrahepatic portosystemic shunt (TIPS) to relieve the symptoms of ascites (This may also help kidney function, but the procedure can be risky.)</li><li>Surgery to place a shunt from the abdominal space to the jugular vein to relieve some symptoms of kidney failure (This procedure is risky and is rarely done.)</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Complications may include:</p><ul><li>Bleeding</li><li>Damage to, and failure of, many organ systems</li><li><a test="test" href="./000500.htm">End-stage kidney disease</a></li><li>Fluid overload and <a test="test" href="./000158.htm">heart failure</a></li><li><a test="test" href="./000302.htm"> Coma caused by liver failure</a></li><li>Secondary infections</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>This disorder most often is diagnosed in the hospital during treatment for a liver disorder.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Cirrhosis - hepatorenal; Liver failure - hepatorenal; HRS</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Fernandez J, Arroyo V. Hepatorenal syndrome. In: Johnson RJ, Floege J, Tonelli M, eds. <em>Comprehensive Clinical Nephrology</em>. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 76.</p><p>Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Cooney KA, eds. <em>Goldman-Cecil Medicine</em>. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 139.</p><p>Mehta SS, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and other systemic complications of liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. <em>Sleisenger and Fordtran's Gastrointestinal and Liver Disease</em>. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 94.</p></div></div></section>
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