Hepatorenal Syndrome
Description
Hepatorenal syndrome is a functional kidney disorder that develops in patients with advanced chronic liver disease, most commonly liver cirrhosis. It is a common complication of cirrhosis, occurring in approximately 40% of affected patients.
Cause
Hepatorenal syndrome develops as a result of severe impairment of renal function in advanced liver disease. Reduced renal perfusion leads to decreased urine output and the accumulation of nitrogenous waste products in the blood (azotemia).
Risk Factors
Risk factors include:
- Orthostatic hypotension.
- Use of diuretic medications.
- Gastrointestinal bleeding.
- Infection.
Symptoms
The main symptoms of hepatorenal syndrome include:
- Ascites (accumulation of fluid in the peritoneal cavity).
- Oliguria with dark-colored urine.
- Weight gain.
- Altered mental status (hepatic encephalopathy or delirium).
- Nausea and vomiting.
Diagnosis
Physical examination may reveal ascites, jaundice, and altered mental status. Blood tests are performed to assess liver and kidney function and evaluate serum electrolyte levels. Urine output is closely monitored and measured.
Treatment
Hepatorenal syndrome is a life-threatening condition. One of the main treatment approaches is plasma volume expansion using intravenous albumin. Vasoconstrictor therapy with agents such as midodrine or ornipressin may also be used. Management is complex, and liver transplantation is the definitive treatment. Despite therapy, the prognosis is often poor.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology