Hepatorenal Syndrome: A Comprehensive Guide to This Severe Liver-Kidney Disorder

Hepatorenal syndrome (HRS) is a condition caused due to kidney damage in individuals with advanced liver diseases. This condition leads to multiorgan failure due to acute injury to the kidney in liver-diseased individuals. Individuals with this condition have both liver disease symptoms and kidney disease symptoms.  

Hepatorenal Syndrome causes:

• Viral hepatitis caused by hepatitis B and C leads to complications like hepatorenal syndrome. In certain areas, liver damage due to specific drugs, alcoholism for a long duration, liver disease like non-alcoholic steatohepatitis, blood flow obstructions due to clots, metabolic diseases, and other viral infections caused by cytomegalovirus and parvovirus also cause this condition.  
• Liver diseases such as cirrhosis and hypertension in the blood vessels trigger the production and release of various chemical mediators. These include nitric oxide and prostaglandins, which dilate the blood vessels, leading to a drop in blood pressure. The blood pressure drop, in turn, triggers various pressure receptors, activating the compensatory mechanisms. This compensatory mechanism leads to decreased blood supply from the heart and narrowing of kidney blood vessels, which damage kidney tissues and result in renal failure.  
• HRS is a complication of liver diseases. The risk of HRS is higher in conditions such as alcoholic hepatitis, cirrhosis, and cancers. Sepsis in any form can trigger HRS due to the release of specific mediators. Individuals with low blood sodium levels, bacterial abdominal infections, and renin hormones also have an increased risk of HRS.  

Hepatorenal syndrome symptoms:

Individuals with HRS show liver failure symptoms. Hepatorenal syndrome exhibits the following symptoms:

• Fatigue, weakness, appetite loss, and nausea
• Yellowing of the white part of the eyes and the skin, leading to jaundice
• Blood clotting disorders leading to severe Bleeding  
• Slow fluid accumulation in the abdomen leading to ascites  
• Loss of proteins such as albumin
• Urination difficulties and reduced amount of urine
• Confusion and mental changes in late stages due to encephalopathy and toxin accumulation
• Liver tissue damage producing toxic products  

Types of Hepatorenal syndrome:

Hepatorenal syndrome is of two kinds. These include:

• Type 1 is severe and progresses quickly with a fast decline in kidney function. Urine output decreases to less than 500ml/day. Poor prognosis with an average survival rate of less than 2 weeks are features of this condition.  
• Type 2 is less severe and progresses slowly, with a slow decline in kidney function. Fluid accumulation seen in this condition does not reduce with medications. Survival in this type varies on the liver disease and can last up to 6-12 months.  
• Other potential causes of kidney diseases, such as dehydration, drug damage, urinary tract blockages, and kidney diseases, should be ruled out.  

Hepatorenal syndrome diagnosis:

Blood tests diagnose HRS, and health care providers establish diagnosis by exclusion. Type 1 HRS shows creatinine levels in blood greater than 2.5, and creatinine clearance tests are reduced by half within a short period.  

Hepatorenal syndrome treatment:

• HRS is managed by maintaining blood volume and stopping all drugs that can damage the kidneys. Treatment targets narrowed blood vessels in the abdomen, which raise blood pressure and restore blood flow to the kidneys.  
• In some parts of the world, a combination of terlipressin and albumin improves blood flow to the kidneys in Type 1 and 2 HRS.  
• Drugs like noradrenaline, midodrine, and octreotide reduce HRS in certain areas.  
• If medications cannot control the condition, Transjugular intrahepatic portosystemic shunt (TIPS) surgery is performed. This surgery creates a shunt or bypass in the liver to reduce blood pressure, redirect blood flow, improve blood flow, and reduce strain on the kidneys.  
• Liver transplantation is the definitive treatment that also provides long-term survival benefits.  
• A molecular adsorbent recirculating system is a modified dialysis technique that removes toxic products such as nitric oxide, tumor necrosis factor, and cytokines.  
• Renal replacement therapy was another treatment option indicated in individuals who cannot undergo TIPS or respond to vasoconstrictors.  
• Long-term antibiotic treatment is advised in individuals who have abdominal fluid accumulation and sepsis.  

Conclusion

Hepatorenal syndrome is a multisystem disorder affecting kidneys in liver-diseased individuals. Diagnosis based on exclusion helps to identify the disease. Fortis Hospital has experienced hepatologists and renal surgeons who can identify the condition using cutting-edge technology and treat the individual to improve outcomes.