When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Síndrome hepatorrenal

Última revisão: 24 Sep 2025
Última atualização: 01 Oct 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • cirrose avançada
  • icterícia
  • ascite
Detalhes completos

Outros fatores diagnósticos

  • diminuição moderada da pressão arterial (PA)
  • edema periférico
  • esplenomegalia
  • aranha vascular
  • oligúria
  • hematomas
  • petéquias
  • eritema palmar
  • marcas de arranhões
  • ginecomastia
  • encefalopatia
  • prurido
  • confusão
  • torpor
Detalhes completos

Fatores de risco

  • cirrose avançada
  • ascite
  • hepatite relacionada ao álcool
  • hiponatremia
  • atividade de renina plasmática (ARP) elevada
  • peritonite bacteriana espontânea
  • paracentese de grande volume
  • sangramento gastrointestinal agudo
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • creatinina sérica
  • ureia
  • eletrólitos
  • Hemograma completo
  • testes hepáticos
  • exame de coagulação
  • paracentese diagnóstica e cultura de líquido ascítico
  • hemocultura
  • urinálise e cultura
  • Radiografia torácica
Detalhes completos

Investigações a serem consideradas

  • ultrassonografia renal
Detalhes completos

Algoritmo de tratamento

Inicial

peritonite bacteriana espontânea (PBE): prevenção da síndrome hepatorrenal (SHR)

suspeita de SHR-LRA

AGUDA

SHR-LRA confirmada

Colaboradores

Autores

Douglas A. Simonetto, MD

Associate Professor of Medicine

Division of Gastroenterology and Hepatology, Department of Medicine

Mayo Clinic

Rochester

MN

Declarações

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

Declarações

KAS declares that she has no competing interests.

Agradecimentos

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

Declarações

JK declares that he has no competing interests.

Revisores

William Carey, MD, MACG, FAASLD

Hepatology Section Head

Cleveland Clinic

Cleveland

OH

Disclosures

WC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

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.
  • Differentials

    • Azotemia pré-renal
    • Necrose tubular aguda - isquêmica
    • Necrose tubular aguda - nefrotóxica
    More Differentials
  • Guidelines

    • Use of albumin infusion for cirrhosis-related complications: an international position statement
    • Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome
    More Guidelines
  • Patient information

    Hepatite C: o que é?

    Hepatite C: quais tratamentos funcionam?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer