Hepatorenal Syndrome (HRS) is a life-threatening condition that affects kidney function in people with advanced liver disease. HRS is most common in people with advanced cirrhosis (or scarring of the liver) and ascites, an abnormal buildup of fluid in the abdomen that is often related to liver disease. But the syndrome can also occur in people with fulminant hepatic failure (acute liver failure) and other types of diseases of the liver.
There are two types of hepatorenal syndrome:
Although HRS can occur in people with advanced liver disease, its exact cause and rate of occurrence are still unknown.
The hallmark of the syndrome is significant narrowing (constriction) of the blood vessels that feed the kidneys. When blood flow to the kidneys is restricted, kidney function declines over time. The exact cause of constriction of the blood vessels feeding the kidneys remains unknown, but some researchers believe it may result from a combination of factors, including high pressure within the portal vein (portal hypertension), which carries blood from the digestive organs to the liver. The most-common cause of portal hypertension is cirrhosis of the liver.
There are various theories on the cause of HRS. The most common theory is that HRS is caused by a narrowing of the blood vessels that feed the kidneys, resulting in reduced blood flow to the kidneys and declining kidney function over time.
Researchers have also identified certain “triggers” that can make it more likely for people with liver disease to develop HRS. Spontaneous bacterial peritonitis (SBP) is the most common of these triggers. SBP is a complication of cirrhosis and ascites. It is an infection of the membrane lining the abdominal cavity. Another cause is too many diuretics (pills that promote urination).
If you have cirrhosis, the following will be important to prevent HRS:
HRS has a variety of nonspecific symptoms, including:
People with HRS may also have symptoms related to advanced liver disease, including:
There is no specific test for HRS. So, it is diagnosed in part by ruling out other causes of acute kidney impairment in patients with advanced liver disease.
Medical professionals conduct a thorough clinical evaluation; take a detailed patient history and order various tests. By doing so, they seek to determine whether certain conditions exist — including advanced liver failure with portal hypertension, and to rule out other causes of kidney impairment, such as:
One of the tests used to diagnose HRS is a common blood test known as a serum creatinine test. The test measures the level of creatinine in the blood, and the results reflect how well the kidneys are functioning. One of the signs of HRS is an abnormally high level of creatinine in the blood. Creatinine is a chemical waste product generated largely by the muscle-metabolism process.
The International Club of Ascites — an organization that encourages scientific research in the field of advanced liver cirrhosis and its complications — has developed its own criteria for the diagnosis of HRS.
Liver transplantation is the best treatment for HRS but may not be an option for people with HRS-1 who are too sick for the operation. People who are either ineligible for a transplant or waiting for one may be given renal replacement therapy (hemodialysis) or medications to improve the flow of blood to the kidneys.
Those affected by HRS may also be advised by their medical team to avoid diuretics (which can worsen kidney function), promptly treat infection, and maintain their electrolyte balance. The major electrolytes in the body include sodium, potassium, calcium, magnesium, phosphate and chloride. Medical providers can determine electrolyte levels with a few tests and recommend how to best address an imbalance.
In some cases, people affected by HRS — particularly those needing dialysis or suffering from advanced kidney failure in the months leading up to a planned liver transplant — may need a kidney transplant as well as a liver transplant.
Even after a successful liver transplant, kidney problems may persist, sometimes requiring dialysis. Dialysis is a treatment that removes waste, salt and extra water from the body and replicates other functions normally done by healthy kidneys.
Potential new treatments are being studied. You can learn about privately and publicly funded clinical studies of treatments for HRS and other conditions at the National Institutes of Health’s clinical trials finder or by clicking here.
Other options for people who are unable to get a transplant or who are awaiting one include:
The prognosis for people with liver failure is much worse if they develop HRS. Most patients die within weeks of the onset of renal (kidney) failure without therapy. In fact, 50% of people die within 2 weeks of diagnosis and 80% of people die within 3 months of diagnosis.
Early detection is critical. People affected by HRS have a higher chance of survival if the condition is diagnosed early; they receive prompt medical treatment for kidney impairment and liver transplant is feasible and available. A liver transplant improves the survival rate for individuals with either type of HRS.
Clinical trials are research studies that test how well new medical approaches work in people. Before an experimental treatment can be tested on human subjects in a clinical trial, it must have shown benefit in laboratory testing or animal research studies. The most promising treatments are then moved into clinical trials, with the goal of identifying new ways to safely and effectively prevent, screen for, diagnose, or treat a disease.
Speak with your doctor about the ongoing progress and results of these trials to get the most up-to-date information on new treatments. Participating in a clinical trial is a great way to contribute to curing, preventing and treating liver disease and its complications.
Start your search here to find clinical trials that need people like you.
Last updated on August 3rd, 2022 at 12:29 pm