Hepatorenal Syndrome: Causes, Diagnosis, Symptoms and Treatments


SHR – by its acronyms – is a form of renal failure that occurs in individuals with advanced liver disease. Individuals with this syndrome have no identifiable cause of renal dysfunction and the kidneys themselves are not structurally damaged.

Therefore, the hepatorenal syndrome can be referred to as a “functional” form of renal failure. In fact, if the kidney of an individual with hepatorenal syndrome were to be transplanted into a healthy individual, he or she would function normally.

Hepatorenal syndrome is classified into two different types

Type I is a rapidly progressive disease that leads to kidney failure, while type II does not have a rapid course and progresses slowly for weeks or months.

Although the syndrome occurs in individuals with liver disease, the exact cause of the disease is unknown. Researchers have observed that blood circulation is abnormal in patients with hepatorenal syndrome.

The arteries that circulate oxygenated blood from the lungs to the rest of the body (systemic circulation) widen in contrast to the arteries of the kidney, which narrow causing a decrease in blood flow through the kidney.


This syndrome occurs when there is a decrease in renal function in an individual with a severe liver disorder. Because the elimination of urine from the body is scarce, the nitrogenous waste products pile up in the bloodstream.

The disorder occurs on average 1 in 10 patients who are in the hospital due to liver failure.

This leads to kidney failure in people with:

  • Acute liver failure.
  • Alcoholic hepatitis
  • Cirrhosis.

Risk factors include:

  • Alternating blood pressure, which changes depending on the person’s position (orthostatic hypotension).
  • The use of diuretics (water pill).
  • Gastrointestinal bleeding.
  • Infection.


  • Abdominal swelling product to the liquid.
  • Change in mental state.
  • Confusion.
  • Delirium.
  • Muscle spasms.
  • Dark colored urine.
  • Decrease in urine production.
  • Nausea and vomiting.
  • Weight gain.
  • Yellow skin.

Tests and tests for diagnosis

This hepatorenal insufficiency is diagnosed when other types of renal failure are ruled out in the tests. Although the physical examination does not clearly reveal kidney failure, it may show signs of chronic liver disease:

  • Unusual reflections.
  • Small testes
  • Noise in the abdominal area.
  • Increase of breast tissue.
  • Skin lesions

Treatment for hepatorenal syndrome

Some of the medications used to treat Hepatorenal Syndrome are: octreotide, midodrine, albumin, or dopamine can be used to optimize blood pressure and temporarily to help the kidneys work better.

A nonsurgical treatment, known as TIPS, is used to pacify the symptoms of ascites and may help kidney function. Surgery to place a treatment called Levine that goes from the abdominal cavity to the jugular vein, can similarly appease several of the symptoms of kidney failure.