Hepatorenal syndrome (HRS)

Definitions

Renal failure
- situation in which the kidneys fail to function adequately

Hepatorenal syndrome
- acute renal failure
- that occurs in the setting of cirrhosis or fulminant liver failure
- sometimes also associated with portal hypertension
- usually in the absence of other disease of the kidney

Pathophysiology

2 Theories

1.

• cirrhosis or fulminant liver failure
• cause portal hypertension
• renal perfusion is maintained by vasodilatory systems
• as liver disease progresses in severity, renal vasodilatory systems are unable to counteract the maximal activation of the endogenous vasoconstrictors and/or intrarenal vasoconstrictors
• leads to uncontrolled renal vasoconstriction.

2.
- unrelated to systemic hemodynamics but is due to either a

• deficiency in the synthesis of a vasodilatory factor OR
• hepatorenal reflex that leads to renal vasoconstriction.