Hepatorenal Syndrome

Hepatorenal syndrome is a very dangerous condition that directly threatens the life of the victim. The syndrome is primarily related to severe liver damage, which is followed by secondary acute renal failure.


Initially, the condition starts with a liver failure with portal hypertension. This situation is usually (not always!) related to chronic liver cirrhosis, which is usually (not always!) related to chronic alcoholism. Liver failure disrupts the blood flow into the kidneys causing their secondary damage.


Note: The main problem is that liver failure with portal hypertension leads (because of increased production of nitric oxide) to dilation of splanchnic (i.e. guts) blood vessel causing local splanchnic congestion. This leads to reduction of blood volume in the circulatory system outside the splanchnic system and drop of the blood pressure. Kidneys try to react by producing hormone renin to maintain the blood pressure, but this reaction further constricts the renal arteries. The combination of low blood pressure and constriction of renal arterioles is very dangerous for the kidney tissue.


Failure of liver and kidneys - two such important organs that help to maintain the stability of the internal environment – is devastating for the organism and it is usually fatal no matter the therapy. The visible manifestation is usually a combination of symptoms of liver cirrhosis and associated portal hypertension (spider angiomas, jaundice, ascites, weight loss, esophageal varices, dementia, etc.), and acute kidney failure (stopped urination, impaired consciousness, mineral imbalance). Details can be found in related texts.


Diagnosis is determined by the symptoms and signs of acute kidney and liver failure in the blood tests. Liver tests are usually high and so are the renal parameters (urea and creatinine). Increased serum level of waste products such as the ammonia is a very bad prognostic sign.


The treatment is individual. Usually, the patients are admitted to the ICU to a monitored bed. The treatment tries to reduce the blood flow through splanchnic blood vessels by special medications and to maintain the cardiovascular system and kidney perfusion. Acute kidney failure may be solved by temporary dialysis. Liver failure and portal hypertension may be treated conservatively or by the so-called TIPS (artificial connection between the hepatic veins and portal system). The ideal treatment option would be a liver transplant, but only minimal part of the patients is able to undergo this difficult and extensive operation.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources