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Hepatorenal Syndrome

Lolwa Al-Obaid, MD, Faruq Pradhan, MBBCh and Fredric D. Gordon, MD, AGAF Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Hepatorenal syndrome (HRS) is a kidney impairment in decompensated liver disease characterized by decreased renal perfusion caused by severe splanchnic vasodilatation in the absence ...

DIAGNOSIS

Major criteria (5
  • Cirrhosis with ascites

  • Serum creatinine >1.5 mg/dL (>133 mmol/L)

  • Absence of hypovolemia—defined by no sustained improvement of renal function (creatinine decreasing to...

TREATMENT

GENERAL MEASURES

  • Discontinue diuretics.

  • Avoid nephrotoxins and contrast agents.

  • Relieve urinary obstruction (if present).

MEDICATION

First Line

  • Vasoconstrictors

    • Terlipressin (not available in the U...

REFERENCES

1
Fagundes C, Ginès P. Hepatorenal syndrome: a severe, but treatable, cause of kidney failure in cirrhosis. Am J Kidney Dis.  2012;59(6):874–885. [View Abstract on OvidMedline]
2
European...

ADDITIONAL READING

  • Singh V, Ghosh S, Singh B, et al. Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study. J Hepatol.  2012;56(6):1293–1298.

  • Tyagi P, Sharma ...

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 

ICD9

572.4 Hepatorenal syndrome 

SNOMED

51292008 Hepatorenal syndrome (disorder) 

CLINICAL PEARLS

  • HRS is a diagnosis of exclusion.

  • Decompensated cirrhosis with ascites and hyponatremia are common in patients with HRS.

  • Medical therapy is typically ineffective in HRS.

  • Liver transplantat...

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