BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuHepatorenal syndromeCirrhosis - hepatorenal; Liver failure - hepatorenalHepatorenal syndrome is a condition in which there is progressive kidney failure that occurs in a person with cirrhosis of the liver. It is a serious complication that can lead to death. CirrhosisCirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.Read Article Now Book Mark Article 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).AzotemiaPrerenal azotemia is an abnormally high level of nitrogen waste products in the blood.Read Article Now Book Mark Article The disorder occurs in up to 1 in 10 people who are in the hospital with liver failure. It leads to kidney failure in people with:Kidney failureAcute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...Read Article Now Book Mark Article Acute liver failure Alcoholic hepatitis HepatitisHepatitis is swelling and inflammation of the liver.Read Article Now Book Mark Article Cirrhosis CirrhosisCirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.Read Article Now Book Mark Article Infected abdominal fluidInfected abdominal fluidThe peritoneum is the thin tissue that lines the inner wall of the abdomen and covers most of the organs. Peritonitis is present when this tissue be...Read Article Now Book Mark Article Risk factors include:Blood pressure that falls when a person rises or suddenly changes position (orthostatic hypotension) Use of medicines called diuretics ("water pills") Gastrointestinal bleeding Infection Recent abdominal fluid removal (paracentesis) Abdominal fluid removalAn abdominal tap is used to remove fluid from the area between the belly wall and the spine. This space is called the abdominal cavity or peritoneal...Read Article Now Book Mark Article Symptoms Symptoms include:Abdominal swelling due to fluid (called ascites, a symptom of liver disease) Abdominal swelling due to fluidAscites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.Read Article Now Book Mark Article Mental confusion ConfusionConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...Read Article Now Book Mark Article Muscle jerks Dark-colored urine (a symptom of liver disease) Dark-colored urineThe usual color of urine is straw-yellow. Abnormally-colored urine may be cloudy, dark, or blood-colored.Read Article Now Book Mark Article Decreased urine output Decreased urine outputDecreased urine output means that you produce less urine than normal. Most adults make at least 500 mL of urine in 24 hours (a little over 2 cups)....Read Article Now Book Mark Article Nausea and vomiting Weight gain Weight gainUnintentional weight gain is when you gain weight without trying to do so and you are not eating or drinking more.Read Article Now Book Mark Article Yellow skin (jaundice, a symptom of liver disease) 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:Confusion (often due to hepatic encephalopathy) Hepatic encephalopathyLoss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy (HE). This problem ma...Read Article Now Book Mark Article Excess fluid in the abdomen (ascites) Jaundice Other signs of liver failure Other signs include:Abnormal reflexes Smaller testicles Dull sound in the belly area when tapped with the tips of the fingers Increased breast tissue (gynecomastia) Sores (lesions) on the skin The following may be signs of kidney failure:Very little or no urine output Fluid retention in the abdomen or extremities Increased BUN and creatinine blood levels BUNBUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...Read Article Now Book Mark Article CreatinineThe creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine can ...Read Article Now Book Mark Article Increased urine specific gravity and osmolality Urine specific gravityUrine specific gravity is a laboratory test that shows the total concentration of all chemical particles in the urine.Read Article Now Book Mark Article OsmolalityOsmolality is a test that measures the concentration of all chemical particles found in the fluid part of blood. Osmolality can also be measured with...Read Article Now Book Mark Article Low blood sodium Blood sodiumThe sodium blood test measures the concentration of sodium in the blood. Sodium can also be measured using a urine test.Read Article Now Book Mark Article Very low urine sodium concentration Urine sodiumThe sodium urine test measures the amount of sodium the urine. Sodium can also be measured in a blood sample.Read Article Now Book Mark Article The following may be signs of liver failure:Abnormal prothrombin time (PT) PTProthrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. A related blood test is ...Read Article Now Book Mark Article Increased blood ammonia level AmmoniaAmmonia is a strong, colorless gas. If the gas is dissolved in water, it is called liquid ammonia. Poisoning may occur if you breathe in ammonia. ...Read Article Now Book Mark Article Low blood albumin Blood albuminAlbumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood. Albumin c...Read Article Now Book Mark Article Paracentesis shows ascites ParacentesisAn abdominal tap is used to remove fluid from the area between the belly wall and the spine. This space is called the abdominal cavity or peritoneal...Read Article Now Book Mark Article Signs of hepatic encephalopathy (an EEG may be done) Hepatic encephalopathyLoss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy (HE). This problem ma...Read Article Now Book Mark Article EEGAn electroencephalogram (EEG) is a test to measure the electrical activity of the brain.Read Article Now Book Mark Article 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:Stopping all unnecessary medicines, especially ibuprofen and other NSAIDs, certain antibiotics, and diuretics ("water pills") Having dialysis to improve symptoms Taking medicines to improve blood pressure and help your kidneys work better; infusion of albumin may also be helpful Placing a shunt (known as TIPS) to relieve the symptoms of ascites (this may also help kidney function, but the procedure can be risky) Surgery to place a shunt from the abdominal space to the jugular vein to relieve some symptoms of kidney failure (this procedure is risky and is rarely done) Outlook (Prognosis) The outcome is often poor. Death often occurs due to an infection or severe bleeding (hemorrhage). Possible Complications Complications may include:Bleeding Damage to, and failure of, many organ systems End-stage kidney disease End-stage kidney diseaseEnd-stage kidney disease (ESKD) is the last stage of long-term (chronic) kidney disease. This is when your kidneys can no longer support your body's...Read Article Now Book Mark Article Fluid overload and heart failure Heart failureHeart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...Read Article Now Book Mark Article Coma caused by liver failure Coma caused by liver failureLoss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy (HE). This problem ma...Read Article Now Book Mark Article Secondary infections When to Contact a Medical Professional This disorder most often is diagnosed in the hospital during treatment for a liver disorder.Open ReferencesReferencesFernandez J, Arroyo V. Hepatorenal syndrome. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 73.Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.Mehta SS, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and other systemic complications of liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 94.AllVideoImagesTogRelated Information Urine output - decreased(Symptoms)Prerenal azotemia(Condition)Liver disease(Condition)Acute kidney failure(Condition)Cirrhosis(Condition)Hepatitis(Condition)Abdominal tap (Medical Test)Loss of brain function - liver disease(Condition)End-stage kidney disease(Condition)Heart failure(Condition)Cirrhosis(In-Depth)Hepatitis(In-Depth)Heart failure(In-Depth) Review Date: 3/31/2020 Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. 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. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- © 1997- All rights reserved. A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.Content is best viewed in IE9 or above, Firefox and Google Chrome browser.