Hepatorenal syndrome
Last reviewed: 23 Apr 2022
Last updated: 01 Mar 2022
Summary
Definition
History and exam
Key diagnostic factors
- advanced cirrhosis
- jaundice
- ascites
More key diagnostic factors
Other diagnostic factors
- moderate lowering of BP
- peripheral edema
- hepatosplenomegaly
- spider angioma
- oliguria
- bruising
- petechiae
- palmar erythema
- scratch marks
- gynecomastia
- encephalopathy
- pruritus
- confusion
- drowsiness
Other diagnostic factors
Risk factors
- advanced cirrhosis
- ascites
- alcoholic hepatitis
- acute liver failure
- hyponatremia
- high plasma renin activity (PRA)
- spontaneous bacterial peritonitis
- large volume paracentesis
- gastrointestinal (GI) bleeding
- salt restriction
More risk factors
Diagnostic investigations
1st investigations to order
- creatinine
- BUN
- electrolytes
- CBC
- LFTs
- coagulation study
- diagnostic paracentesis and culture of ascitic fluid
- blood culture
- urinalysis and culture
- Chest x-ray
More 1st investigations to order
Investigations to consider
- renal ultrasound
More investigations to consider
Treatment algorithm
INITIAL
spontaneous bacterial peritonitis (SBP): prevention of HRS
alcoholic hepatitis: prevention of HRS
suspected HRS
ACUTE
confirmed HRS-AKI
Contributors
Authors
John Kepros, MD
Trauma Medical Director
HonorHealth Osborn Hospital
Scottsdale
AZ
Disclosures
JK declares that he has no competing interests.
Peer reviewers
Howard J. Worman, MD
Professor of Medicine and Cell Biology
Columbia University College of Physicians and Surgeons
New York
NY
Disclosures
HJW declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Differentials
- Prerenal azotemia
- Acute tubular necrosis - ischemic
- Acute tubular necrosis - nephrotoxic
More DifferentialsGuidelines
- Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome
- EASL clinical practice guidelines for the management of patients with decompensated cirrhosis
More GuidelinesPatient leaflets
Hepatitis C: what is it?
Hepatitis C: what treatments work?
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer