Hepatorenal syndrome natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Natural History

Pre-ascites Phase

• Systemic vasodilatation causes kidneys to retain sodium and water, thereby overcoming the compensatory renal vasoconstriction. This prevents the drop in glomerular filtration rate and subsequent vasoconstriction of renal arterioles.

Complications

• Bleeding
• Damage to, and failure of, many organ systems (multiorgan system failure)
• End-stage kidney disease
• Fluid overload with congestive heart failure or pulmonary edema
• Hepatic coma
• Secondary infections
• Death

Prognosis

• Type I HRS carries a very poor prognosis, usually of less than 50% over one month. Patients with type I hepatorenal syndrome are usually ill, may have low blood pressures, and may require therapy with inotropes, or intravenous drugs to maintain blood pressure.

• It is typically associated with ascites that is unresponsive to diuretic medications, and also carries a poor, if somewhat longer (median survival ~6 months) outlook, unless the patient undergoes liver transplantation.