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Hepatorenal syndrome

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Hepatorenal syndrome is a condition in which there is progressive kidney failure in a person with cirrhosis of the liver. It is a serious and often life-threatening complication of cirrhosis.

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Causes
Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a severe liver disorder. Because less urine is removed from the body, nitrogen-containing waste products build up in the bloodstream (azotemia).

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

A physical examination does not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease, including: 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 your liver work better and to make sure your heart is pumping enough blood to your body.

Treatment is generally the same as kidney failure due to any cause.
Outlook (Prognosis)
The predicted outcome is poor. Death is usually the result of a secondary 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. Cecil Medicine . 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 156.

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

Update Date: 5/1/2012
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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