Hepatorenal syndrome occurs when the kidneys start to fail in a person with advanced liver disease. This condition causes the blood vessels of the kidneys to become narrow, making it difficult to carry blood to the kidneys. This constriction prevents the kidneys from performing their filtration functions and impairs the body's ability to maintain blood pressure.
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What Is Hepatorenal Syndrome?
Hepatorenal syndrome is a condition that affects the kidneys as a result of advanced liver disease. Chronic or acute liver disease can lead to the narrowing of the blood vessels that supply the kidneys. If these vessels are blocked, then the kidneys cannot perform their filtration duties, which will lead to excess fluid and waste becoming present in the blood.
This blockage can also impact the blood pressure of the body and lead to further damage to the kidneys and the liver. If you have reached the point of HRS, the only option for treatment is surgery to transplant a healthy liver in place of your damaged liver. It may also require medication to improve the blood flow to the kidneys.
What are the types of hepatorenal syndrome?
There are two types of HRS.
- Type 1 (acute) — Also called HRS1, symptoms come on fast as the kidneys stop working.
- Type 2 — In HRS2, the symptoms are the same, but the disease progresses at a slower pace. With type 2, it takes months (instead of days or weeks) for the kidneys to fail.
How common is hepatorenal syndrome?
Approximately 4.5 million adults (1.8% of the adult population) have been diagnosed with some form of liver disease
HRS is a complication of liver failure that occurs in about 4% of the 4.5 million American adults who have liver disease. Most commonly, this condition is associated with people who have contracted hepatitis B or C that has damaged their livers to the degree that HRS develops. Other causes of liver failure include alcoholic hepatitis, cirrhosis, or metastatic cancers.
About 10% of people in the hospital with liver failure have HRS. The exact rate of occurrence is unknown.
What causes hepatorenal syndrome?
While the direct causes of hepatorenal syndrome are not fully understood, the condition only occurs in people who already have liver disease.
Hepatorenal syndrome risk factors
HRS is a condition that arises from liver failure. Habits that can worsen the condition of liver disease, such as drinking alcohol or using drugs, continue to damage the liver and increase your chances of developing HRS.
Doctors don't know the exact cause of HRS, but it's always a complication of liver disease. Anyone with advanced liver disease is at risk for HRS.
That includes people with:
Other risk factors include:
- Ascites — The buildup of fluid in the abdominal cavity.
- Gastrointestinal bleeding.
- Unstable blood pressure.
- Use of water pills.
- Infections.
Complications of hepatorenal syndrome
If left undiagnosed, HRS can be very serious — even deadly. As this condition is a side effect of liver disease, the main complications will also affect the liver’s ability to function and will be impacted by habits that can damage the liver.
How can I prevent hepatorenal syndrome?
The only sure way to prevent HRS is to keep your liver healthy. People who drink too much or contract hepatitis are at risk for liver disease.
If you already have liver disease, avoid:
- Contrast dyes used in imaging tests, such as MRIs and CT scans.
- Excessive amounts of alcohol.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such as Advil and Motrin), and naproxen (Aleve).
What Are the Signs and Symptoms of Hepatorenal Syndrome?
HRS almost always happens to people who are already in the hospital with advanced liver disease.
Your doctor may notice the following symptoms of HRS:
- A yellow tint to the skin and eyes (jaundice), caused by too much bilirubin in the blood.
- Ascites — Abnormal build-up of fluid in the abdomen.
- Enlarged spleen.
- Fatigue.
- High levels of creatinine (a chemical waste product) in the blood.
- Hyponatremia (low blood sodium), a possible sign of kidney failure.
- Reduction in urination.
- Temporary confusion and/or memory loss (hepatic encephalopathy).
When should I see a doctor about my hepatorenal syndrome symptoms?
The effects of hepatorenal syndrome are a direct result of ongoing liver disease or liver failure. If you have been experiencing the symptoms of these conditions, you should already be in contact with your doctor about treating your liver disease. However, if you have not seen your doctor for these conditions and are experiencing these symptoms, you should immediately go to the emergency room.
Doctors in the emergency room will be able to ensure you are stable enough to receive other treatments for your condition. This will include putting you on the waiting list for a liver transplant, which is the ultimate solution for liver disease and failure.
How Do You Diagnose Hepatorenal Syndrome?
There's no test for HRS.
If you have symptoms, doctors will run blood and urine tests to rule out other problems, such as:
- A bacterial infection.
- A urinary tract or kidney infection.
- Recent treatment with drugs that affect the kidneys (nephrotoxic drugs).
- Shock (which causes a sudden drop in blood flow throughout the whole body).
What Happens During Hepatorenal Syndrome Treatment?
Sometimes people have to wait for a transplant or are too sick to survive the surgery.
The UPMC Center for Liver Care offers these options to treat your HRS and prolong your life:
- Medicine to help improve blood flow to the kidneys — These include drugs to increase blood pressure if it's too low, and albumin to improve kidney function. If you're taking water pills, your doctor may stop them.
- Dialysis to improve blood flow to the kidneys — Dialysis is a treatment that removes waste products and excess fluid from your blood when your kidneys don't work.
How effective is treatment?
Partial or complete liver transplant surgeries can be very effective, but it's all dependent on the body’s reaction to the new liver. If the new liver is accepted by the body and the healing process goes smoothly, there may be no need for future treatment outside of monitoring liver condition. However, if the body is not accepting of the new liver, there can be complications that lead to liver failure and may require another liver transplant.
How long does it take to recover after surgery for hepatorenal syndrome?
Liver transplant surgery may require a few days in the hospital. Surgery can take up to 12 hours of operation to complete a partial or complete liver transplant. After the surgery, you will need to remain in the hospital to monitor your body’s acceptance of the liver and the healing of the surgery.
Once your care team can confirm you are healthy enough to be discharged, you will be released from the hospital.
Why Choose UPMC for Hepatorenal Syndrome Care?
The UPMC focuses on early diagnosis and treatment for HRS.
- We offer expert care for people with advanced liver disease.
- We're at the forefront of liver research, meaning you have access to clinical trials and the latest advancements in care.
And UPMC in Pittsburgh, Pa., is home to one of the oldest and most experienced transplant centers in the country. We are an international leader in living-donor liver transplants.
