Risk factors for development of HRS include hyponatremia, low urine sodium, hyperkalemia, ascites, and worsening renal function. Presentation varies based on the type of hepatorenal syndrome, but in general patients present with low urine output and worsening creatinine values:
- Type 1 HRS – Rapid and progressive renal dysfunction in patients with underlying spontaneous bacterial peritonitis (SBP). Renal failure often progresses despite treatment of SBP with antibiotics; mortality remains high with death often within 10 weeks.
- Type 2 HRS – Moderate and stable reduction in the glomerular filtration rate (GFR) that occurs in patients with relatively preserved hepatic function and diuretic resistance. Death often occurs in 3-6 months.
- Low GFR with a serum creatinine >1.5 mg/dl or 24-hour creatinine clearance <40 ml/min.
- Absence of shock, fluid losses, ongoing bacterial infection, or use of nephrotoxic medications.
- No sustained improvement in renal function despite plasma expansion with 1.5 L of plasma expander or diuretic withdrawal.
- Proteinuria <500 mg/day and no ultrasonographic evidence of uropathy or intrinsic parenchymal disease.
K76.7 – Hepatorenal syndrome
51292008 – Hepatorenal syndrome