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Hepatorenal Syndrome (HRS)

Contact the UPMC Center for Liver Diseases

To schedule an appointment with a hepatologist at the UPMC Center for Liver Diseases, call 412-647-1170 or fill out our contact form.


What Is Hepatorenal Syndrome (HRS)?

HRS occurs when the kidneys start to fail in a person with advanced liver disease.

In HRS, the blood vessels that feed the kidneys become narrow, making it harder for these veins to transport blood.

Because the kidneys don't get enough blood, they can't do their job of filtering waste and maintaining blood pressure.

HRS is life-threatening, and people should seek treatment as soon as possible.

About 10% of people in the hospital with liver failure have HRS. The exact rate of occurrence is unknown.

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.

Hepatorenal syndrome complications and risk factors

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.
  • Gastrointestinal bleeding.
  • Unstable blood pressure.
  • Use of water pills.
  • Infections.

How to prevent HRS

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:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such as Advil and Motrin), and naproxen (Aleve).
  • Contrast dyes in imaging tests, such as MRIs and CT scans.
  • Excessive amounts of alcohol.

Why Choose UPMC for Hepatorenal Syndrome Care?

The UPMC Center for Liver Diseases:

  • Focuses on early diagnosis and treatment for HRS.
  • Offers expert care for people with advanced liver disease.
  • Is at the forefront of liver research. This means 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 also a leader in living-donor liver transplants.

Hepatorenal Syndrome (HRS) Symptoms and Diagnosis

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.
  • An abnormal build-up of fluid in the abdomen (ascites).
  • Reduction in urination.
  • An enlarged spleen.
  • Fatigue.
  • Temporary confusion and/or memory loss (hepatic encephalopathy).
  • High levels of creatinine (a chemical waste product) in the blood.
  • Hyponatremia (low blood sodium), a possible sign of kidney failure.

Diagnosing 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:

  • Urinary tract or kidney disease.
  • A bacterial infection.
  • Shock (which causes a sudden drop in blood flow throughout the whole body).
  • Recent treatment with drugs that affect the kidneys (nephrotoxic drugs).
  • Overuse of water pills.

Liver Transplant to Treat Hepatorenal Syndrome (HRS)

It's vital to treat HRS as quickly as possible.

The only cure for HRS is a liver transplant. The kidneys will often heal once you have a healthy liver.

In some cases, those affected by HRS will also need a kidney transplant.

The experts at the UPMC Liver Transplant Program provide the best care possible for any transplant surgery.

Medicine and dialysis while you wait for transplant

Sometimes people have to wait for a transplant or are too sick to survive the surgery.

The UPMC Center for Liver Diseases 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.