Hepatorenal Syndrome (HRS-AKI): Nursing Surveillance and Safe Therapy in Advanced Cirrhosis

Hepatorenal syndrome (HRS) is kidney failure caused by the circulatory disturbances of advanced liver disease with possible coexisting structural kidney injury. It occurs mainly in clients with cirrhosis and ascites, and less often in acute liver failure or severe alcohol-associated hepatitis. The rapidly progressive form is called HRS-AKI (formerly "type 1 HRS"); a slower, chronic form (HRS-NAKI, formerly "type 2") accompanies refractory ascites. Without treatment, HRS-AKI has a high short-term mortality. Early recognition by the registered nurse, removal of triggers, intravenous albumin and vasoconstrictor therapy can reverse the kidney injury in some clients and keep them well enough for liver transplant assessment, the only definitive cure. Canadian practice reports laboratory values in SI units: creatinine in µmol/L, sodium and potassium in mmol/L, albumin in g/L. This lesson uses those units throughout.