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Hepatorenal Syndrome

Joanna Jiang, MD Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Hepatorenal syndrome (HRS) is kidney impairment in decompensated liver disease due to decreased renal perfusion that is secondary to severe splanchnic vasodilatation in the absence o...

DIAGNOSIS

Major criteria (7
  • Cirrhosis with ascites

  • Increase in serum Cr of 0.3 mg/dl or more within 48 hours; or a 50% or more increase in baseline creatinine over seven days or urine volume <0.5 ...

TREATMENT

Effective in only 40–50% of cases and it recurs in up to 50% of those cases responding to treatment 

GENERAL MEASURES

  • Abstinence from alcohol

  • Effective antiviral therapy

  • Discontinue diuretics.

  • Av...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Monitor renal and hepatic function and serum electrolytes.

  • Ambulatory follow-up with hepatology and nephrology

DIET

Low-sodium (2 g) diet, in addit...

REFERENCES

1
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ, 2020;370:m2687.
2
Amin AA, Alabsawy EI, Jalan R, et al. Epidemiology, pathophysiology...

ADDITIONAL READING

  • Singh  V, Ghosh  S, Singh  B, et al. Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study. J Hepatol. ...

SEE ALSO

  • Cirrhosis of the Liver; Hepatitis A; Hepatitis B; Hepatitis C

  • Algorithms: Acetaminophen Poisoning, Treatment; Acute Kidney Injury (Acute Renal Failure)

CODES

ICD10

K76.7 Hepatorenal syndrome 

SNOMED

51292008 Hepatorenal syndrome (disorder) 

CLINICAL PEARLS

  • HRS is a diagnosis of exclusion associated with high mortality

  • Decompensated cirrhosis with ascites and hyponatremia are common in patients with HRS. Outcomes are linked to reversal of ...

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