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Síndrome hepatorrenal

Last reviewed: 25 Jun 2025
Last updated: 01 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • cirrosis avanzada
  • ictericia
  • ascitis
Full details

Other diagnostic factors

  • disminución moderada de la presión arterial
  • edema periférico
  • esplenomegalia
  • angioma aracniforme
  • oliguria
  • hematomas
  • petequias
  • eritema palmar
  • lesiones de rascado
  • ginecomastia
  • encefalopatía
  • prurito
  • confusión
  • somnolencia
Full details

Risk factors

  • cirrosis avanzada
  • ascitis
  • hepatitis relacionada con el alcohol
  • hiponatremia
  • elevada actividad de la renina plasmática (ARP)
  • peritonitis bacteriana espontánea
  • paracentesis de gran volumen
  • sangrado gastrointestinal (GI)
Full details

Diagnostic tests

1st tests to order

  • creatinina sérica
  • urea
  • electrolitos
  • hemograma completo (HC)
  • pruebas hepáticas
  • estudio de coagulación
  • paracentesis diagnóstica y cultivo de líquido ascítico
  • hemocultivo
  • cultivo y análisis de orina
  • Radiografía de tórax
Full details

Tests to consider

  • ultrasonido renal
Full details

Treatment algorithm

INITIAL

peritonitis bacteriana espontánea (PBE): prevención del SHR

sospecha de SHR-DRA

ACUTE

SHR-DRA confirmado

Contributors

Authors

Douglas A. Simonetto, MD

Associate Professor of Medicine

Division of Gastroenterology and Hepatology, Department of Medicine

Mayo Clinic

Rochester

MN

Disclosures

DAS has done consultancy work for Mallinckrodt, Evive, Resolution Therapeutics, and BioVie. DAS is an author of a reference cited in the topic.

Kathryn A. Schmidt, MD

Division of Gastroenterology and Hepatology, Department of Medicine

Mayo Clinic

Rochester

MN

Disclosures

KAS declares that she has no competing interests.

Acknowledgements

Dr Douglas A. Simonetto and Dr Kathryn A. Schmidt would like to gratefully acknowledge Dr John Kepros, the previous contributor to this topic.

Disclosures

JK declares that he has no competing interests.

Peer reviewers

William Carey, MD, MACG, FAASLD

Hepatology Section Head

Cleveland Clinic

Cleveland

OH

Disclosures

WC declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.Full text  Abstract

Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687.Full text  Abstract

European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Full text  Abstract

European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010 Sep;53(3):397-417.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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