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Hepatorenal syndrome

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Hepatorenal syndrome is a condition in which there is progressive kidney failure. It occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death.

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Causes
Hepatorenal syndrome occurs when the kidneys stop working well in people with serious liver problems. Less urine is removed from the body, so waste products that contain nitrogen build up in the bloodstream (azotemia).

The disorder occurs in up to 1 in 10 patients who are in the hospital with liver failure. It leads to kidney failure in people with: Risk factors include:
Exams and Tests
This condition is diagnosed after testing to rule out other causes of kidney failure.

A physical exam does not detect kidney failure directly. However, the exam will very often show signs of chronic liver disease, such as: Other signs include: The following may be signs of kidney failure: The following may be signs of liver failure:
Treatment
The goal of treatment is to help the liver work better and to make sure the heart is able to pump enough blood to the body.

Treatment is about the same as for kidney failure from any cause. It includes:
Outlook (Prognosis)
The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage).

When to Contact a Medical Professional
This disorder most often is diagnosed in the hospital during treatment for a liver disorder.

References
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L,Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 156.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet . 2008;371:838-851.

Update Date: 5/15/2014
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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