Hepatorenal syndrome classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

The classification of hepatorenal syndrome is based on the deteriorating function of kidney.

Classification

The hepatorenal syndrome is defined as renal failure that occurs in the setting of liver disease as follows:

Type I HRS

Type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 221 μmol/L (2.5 mg/dL) or a halving of the creatinine clearance to less than 20 mL/min over a period of less than 2 weeks.

Type II HRS

Type II HRS is characterized by a slowly progressive:

• Increase in serum creatinine level to greater than 133 μmol/L (1.5 mg/dL) or a creatinine clearance of less than 40 mL/min.
• Urine sodium < 10 meq/dl.

Classification on basis of mechanism of kidney injury in presence of liver failure:

1. Hypovoluemia induced kidney injury: It occurs due to loss of fluid through GIT or GI bleed in presence of liver failure which predisposed kidney to hypovolumic injury.
2. Parencheymal renal disease: In presence proteinuria above 500 mg/dl and hematuria above 50 red cells points to kidney injury primarily otherwise it points to liver damage promoting kidney injury.
3. Drug induced hepato-nephrotoxicity: When drugs like acetaminophen and anti microbial causing hepatotoxicity and nephrotoxicity are taken together they can also produce combed damage.