Printer Friendly VersionEmail A FriendAdd ThisIncrease Text SizeDecrease Text Size

Hepatorenal syndrome



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.


Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a 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 10% of patients hospitalized with liver failure. It is caused by the mounting effects of liver damage and leads to kidney failure in people with:

Risk factors include:

  • Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension)
  • Diuretic use
  • Gastrointestinal bleeding
  • Infection
  • Recent abdominal fluid tap (paracentesis)
Signs 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:

Other signs include:

  • Abnormal reflexes
  • Decreased testicle size
  • Dull sound in the abdomen when tapped with the tips of the fingers, and visible fluid wave when examined by feel
  • Increased breast tissue (gynecomastia)
  • Sores (lesions) on the skin

The following may be signs of kidney failure:

The following may be signs of liver failure:

Support Groups

Expectations (prognosis)

The predicted outcome is poor. Death usually occurs as a result of secondary infections or hemorrhage.

Calling your health care provider

This disorder most often is diagnosed in the hospital during treatment for a liver disorder.


Treatment aims to improve liver function and ensure that there is enough blood volume in the body and that the heart is pumping it adequately.

The disorder is generally treated in the same way as kidney failure from any other cause.

  • All unnecessary medicines should be stopped, especially the antibiotic neomycin, ibuprofen and other NSAIDs, and diuretics ("water pills").
  • Dialysis may improve symptoms.
  • Medications such as octreotide plus midodrine, albumin, or dopamine may be used temporarily to improve kidney function.
  • A nonsurgical shunt (known as TIPS) is used to relieve the symptoms of ascites and may help kidney function. Surgery to place a shunt (called a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may also relieve some of the symptoms of kidney failure. Both procedures are risky and proper selection of patients is very important.


Garcia-Tsao G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 157.

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

Review Date: 5/4/2010
Reviewed By: 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, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Home Page
Why Choose Us
Website Terms of Use

Visitor & Patient Info
Patient Portal
We Speak Your Language
Patient Privacy
Contact Us

Find a Physician
Medical Services
Maimonides In the News
Directions & Parking

Medical Education
Career Opportunities
Nurses & Physicians
Staff Intranet Access
Maimonides Medical Center    |    4802 Tenth Avenue    |    Brooklyn, NY 11219    |    718.283.6000    |