Hepatorenal Syndrome

Abdussalam Shredi MD, Sakolwan Suchartlikitwong MD, Hawa Edriss MD


Hepatorenal syndrome is a form of acute kidney injury that occurs in chronic liver disease and acute fulminant liver failure. This syndrome features a rapid progressive decline in renal function in the absence of other obvious causes of renal dysfunction. The pathophysiology of this syndrome is still not completely understood, and several mechanisms have been proposed to explain its pathogenesis. The characteristic feature of hepatorenal syndrome is intense renal vasoconstriction. The local production of vasodilator substances as a result of portal hypertension have a central role in the pathogenesis of the hepatorenal syndrome as they lead to splanchnic pooling and decreased effective systemic arterial plasma volume and renal vasoconstriction. Hepatorenal syndrome is a diagnosis of exclusion and is considered a challenging medical condition in both diagnosis and treatment as it is associated with a poor prognosis. This article will review the two main hypotheses about the pathogenesis, diagnostic criteria, and treatment approaches to the hepatorenal syndrome.

Keywords: hepatorenal syndrome, liver cirrhosis, portal hypertension, splanchnic vasodilatation, nitric oxide, hepatorenal reflex

Article citation: Shredi A, Suchartlikitwong S, Edriss H. Hepatorenal Syndrome. Southwest Respiratory and Critical Care Chronicles 2018;6(22):21–28.
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
Submitted: 7/23/2017
Accepted: 1/6/2018
Reviewers: Sreeram Parupudi MD
Conflicts of interest: none