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Hepatorenal Syndrome

Joanna Jiang, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Hepatorenal syndrome (HRS) is kidney dysfunction associated with decompensated liver disease. This is due to decreased renal perfusion that is secondary to severe splanchnic vasodila...

DIAGNOSIS

  • Criteria for AKI (KDIGO): Increase in serum creatinine of at least 0.3 mg/dL in 48 hours or a 50% increase in serum creatinine over baseline in 7 days or urine output of less than 0.5 mL/kg/...

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.

  • A...

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
Amin AA, Alabsawy EI, Jalan R, et al. Epidemiology, pathophysiology, and management of hepatorenal syndrome.  Semin Nephrol. 2019;39(1):17–30.

ADDITIONAL READING

Ojeda-Yuren AS, Cerda-Reyes E, Herrero-Maceda MR, et al. An Integrated Review of the Hepatorenal Syndrome. Ann Hepatol. 2021:22:100236. doi: 10.1016/j.aohep.202...

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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