Hepatorenal syndrome

Hepatorenal syndrome (HRS) is a serious condition where the kidneys stop working well in people with severe liver problems. It can be deadly unless the person gets a liver transplant. Treatments like dialysis can help slow down the problem.

HRS develops in patients with liver disease; examples of such disease are cirrhosis and severe alcoholic hepatitis. It generally develops when the liver suddenly deteriorates because of events such as infections, bleeding in the stomach, and excessive administration of diuretics (water pills). Some 18% of patients with cirrhosis develop HRS within one year and 39% within five years.

The liver problems cause changes in blood flow, which affects the kidneys. This doesn’t directly damage the kidneys but makes them work poorly. Doctors diagnose HRS with blood tests. There are two types of HRS:

Type 1: The kidney function becomes worse very fast.

Type 2: Causes fluid buildup in the abdomen that doesn’t get better with water pills.

The risk of dying from HRS is very high, especially with Type 1. The best long-term treatment is a liver transplant. While awaiting transplantation, other treatments are often necessary to manage blood flow, including medications and placing a special shunt (TIPS) that reduces blood pressure in the liver. Some might need dialysis to help the kidneys or a special liver dialysis to remove toxins until they can get a transplant.