Hepatorenal syndrome

Alternative names:

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

Symptoms:

• decreased urine production
• dark colored urine
• skin jaundiced (yellow-orange color)
• weight gain
• abdominal swelling
• change in mental status
  • dementia, delirium, confusion

• coarse muscle movements, jerking
• nausea
• vomiting
• blood in vomit
• blood in the stools

Signs and tests:

Examination may reveal hepatic encephalopathy, jaundice, ascites, and other signs of liver failure along with the decrease in kidney functioning. Deep tendon reflexes are increased and abnormal reflexes may be present, indicating damage to the nervous system. The abdomen is dull on examination by tapping with the tips of the fingers (percussion), often with a visible fluid wave when examined by touch (palpation). There may be increased breast tissue, decreased testicular size, lesions (spider telangiectasia) on the skin, or other signs of liver failure.

Liver failure may be indicated by:

• low serum albumin
• abnormal PT
• increased ammonia levels
• paracentesis with ascites.

An EEG may be performed if signs of hepatic encephalopathy are present.

Kidney failure may be indicated by:

• absent or low urine production , less than 400 cc/day.
• very low urine sodium concentration
• increased urine specific gravity and osmolality
• low serum sodium
• increased BUN and creatinine levels (Note: In people with liver disease, the BUN and creatinine levels underestimate the severity of kidney dysfunction.)