Hepatorenal Syndrome

Hepatorenal syndrome (HS) is a group of diseases characterized by chronic inflammation of the liver. HS are caused by several different viruses, bacteria, fungi and parasites. They have been reported from various parts of the world including India, China, Africa and Europe. Some countries like USA and UK do not report any cases of HS. The disease is usually diagnosed based on history or physical examination findings. However there are other tests such as biopsy which may confirm diagnosis if present.

The main symptom of hepatitis is jaundice (yellowing of skin and eyes). Other symptoms include fatigue, loss of appetite, nausea, vomiting, abdominal pain and diarrhea.

Liver damage results in cirrhosis (scarring), which leads to irreversible organ failure. There are two forms of hepatic encephalopathy: primary and secondary. Primary encephalopathies are due to viral infections while secondary ones are due to bacterial infection or parasitic infection.

Primary encephalopathies are usually fatal. Secondary encephalopathies are often reversible but require long term care.

Treatment options include anti-viral drugs, chemotherapy and surgery. Hepatitis B virus (HBV) is the most common cause of primary encephalopathy, followed by HBV type 1 and 2. Hepatitis C virus (HCV) causes approximately 40% of primary encephalopathies worldwide.

Hepatorenal syndrome (HS) is the result of liver disease. It results in kidney damage and kidney failure.

It is mostly caused by toxic substances, autoimmune disease, ischemia and drug-induced. It is a life-threatening condition that requires immediate medical attention. There are no specific treatments available for HS. The only option is to give supportive care to the patient.

What is hepatorenal syndrome?

Hepatorenal syndrome is a condition where the liver fails to perform its normal functions, and also damages the kidneys. This damage leads to kidney failure. If you have hepatorenal syndrome, you might not be able to eliminate waste from your body properly. This can cause toxins to build up in your blood.

Hepatorenal syndrome is an uncommon condition. However, it can be life-threatening.

What are the types of hepatorenal syndrome?

Hepatorenal syndrome is classified as primary or secondary.

Primary hepatorenal syndrome

Primary hepatorenal syndrome is the result of liver disease. It is also known as Child-Pugh grade A hepatorenal syndrome.

In this type of hepatorenal syndrome, the liver disease causes both liver and kidney damage.

Secondary hepatorenal syndrome

Secondary hepatorenal syndrome is the result of diseases that cause both kidney and liver damage. These include diabetes, heart failure, cirrhosis of the liver, widespread cancers and some autoimmune diseases such as lupus.

It is also known as Child-Pugh grade B hepatorenal syndrome.

Is it contagious?

Hepatorenal syndrome is not contagious. It is not caused by a virus or bacteria and therefore cannot be ‘caught’ like a common cold or influenza.

What causes hepatorenal syndrome?

In primary hepatorenal syndrome, the liver disease causes both liver and kidney damage. In secondary hepatorenal syndrome, the kidney disease causes both liver and kidney damage.

However, in some cases the cause is unknown (idiopathic).

What are the risk factors of hepatorenal syndrome?

Risk factors for hepatorenal syndrome include having:

irreversible liver disease, such as cirrhosis, hepatitis or liver cancer

kidney disease which can be caused by diabetes, hypertension or autoimmune conditions such as lupus.

What are the symptoms of hepatorenal syndrome?

The main symptom of hepatorenal syndrome is kidney failure. Other symptoms include nausea, loss of appetite, fatigue, confusion and itchy skin.

How does the doctor diagnose hepatorenal syndrome?

Your doctor will perform a physical examination and ask you about your medical history. They may order blood and urine tests to diagnose hepatorenal syndrome.

You may also have an abdominal ultrasound or computed tomography (CT) scan, to look for the cause of liver disease. Your doctor may refer you to a gastroenterologist (a doctor who specialises in diagnosing and treating diseases of the stomach and intestines).

How is hepatorenal syndrome treated?

Hepatorenal syndrome is a serious condition that requires immediate medical attention. Your doctor will closely monitor your kidney function and remove waste and excess water from your blood to improve kidney functioning.

Any underlying conditions that are causing the liver and kidney damage should be treated. For example, if you have cirrhosis, your doctor will refer you to a specialist for an opinion on whether you need a liver transplant.

Some people with hepatorenal syndrome may need to undergo dialysis to remove excess waste and water from the blood.

What is the outlook for hepatorenal syndrome?

The outlook is related to the cause of liver and kidney failure. In some cases, hepatorenal syndrome causes death. However, in others it may improve after treatment of the underlying condition.

Sources & references used in this article:

Hepatorenal syndrome by P Ginès, M Guevara, V Arroyo, J Rodés – The Lancet, 2003 – Elsevier

Circulatory function and hepatorenal syndrome in cirrhosis by L Ruiz‐del‐Arbol, A Monescillo, C Arocena… – …, 2005 – Wiley Online Library

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis by V Arroyo, P Ginès, AL Gerbes, FJ Dudley, P Gentilini… – Hepatology, 1996 – academia.edu