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 hepato-renal 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[1]
Classification on basis of mechanism of kidney injury in presence of liver failure:
- 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.
- Parencheymal renal disease: In presence protienurea above 500 mg/dl and hemeturia above 50 red cells points to kidney injury primarily otherwise it points to liver damage promoting kidney injury.
- Drug induced hepato-nephrotoxicity: When drugs like acetaminophen and anti microbial causing hepatotoxicty and nephrotoxicity are taken together they can also produce combed damage.