Hepatorenal syndrome

Alternative names:

bile nephrosis; cholemic nephrosis; Flint's syndrome; Heyd's syndrome

Definition:

Acute renal failure occurring without other cause in a person with severe liver disease.

Causes, incidence, and risk factors:

Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. This is often exhibited by decreased urine production. Nitrogen-containing waste products accumulate in the blood stream (azotemia).

The exact cause of hepatorenal syndrome is unknown. There is an unclear relationship between the liver and the kidney, but in hepatorenal syndrome there is a drastic reduction in blood flow to the kidneys. The kidney structure remains essentially normal and the kidneys often will instantly function well if the liver disease is corrected (for example, by liver transplantation).

The disorder occurs in about 4 out of 10,000 people. It may be a sign of impending death caused by the accumulated effects of liver damage and kidney failure in people with acute liver failure, cirrhosis, or alcoholic hepatitis. It is diagnosed when other causes of kidney failure are ruled out.

Risk factors include cirrhosis, alcoholic hepatitis, acute liver failure, recent abdominal paracentesis, gastrointestinal bleeding, use of diuretics, and the presence of orthostatic hypotension (blood pressure falls when the person rises or suddenly changes position).