Overview
Clinical Meaning
Hepatorenal syndrome (HRS) is a functional acute kidney injury that develops in advanced cirrhosis, usually with portal hypertension and ascites.
Hepatorenal syndrome (HRS) is a functional acute kidney injury that develops in advanced cirrhosis, usually with portal hypertension and ascites. The kidneys initially lack the primary structural injury seen in acute tubular necrosis or glomerulonephritis; instead, renal blood flow and filtration fall because the circulation around the kidneys has become profoundly vasoconstricted. HRS-AKI is the time-sensitive form. A modest creatinine rise can represent a major decline in filtration in a patient with cirrhosis because sarcopenia may keep the baseline creatinine deceptively low. The current definition therefore depends on a change from baseline, not on waiting for creatinine to reach the former threshold of 221 µmol/L. HRS is a diagnosis of exclusion. A patient with cirrhosis and rising creatinine may instead have volume-responsive hypoperfusion, sepsis-associated kidney injury, nephrotoxic injury, obstruction, or intrinsic renal disease. Those causes must be actively sought while HRS treatment is being considered.