Liver and Kidney Issues – Hepatorenal Syndrome

People who experience liver disease have problems with blood circulation. This can damage the kidneys over time. When liver and kidney issues occur at same time, this is known as hepatorenal syndrome.

 

However, researchers do not understand the accurate process through which liver disease harms the kidneys, nor why some individuals with end-stage kidney and liver failure develop hepatorenal syndrome and others do not.

 

Hepatorenal syndrome causes end-stage kidney failure in people with liver failure or advanced liver disease.

What is hepatorenal syndrome (HRS)?

Hepatorenal syndrome (HRS) is a fatal complication of advanced liver disease that causes kidney issues. It leads to prerenal acute kidney failure. That means that it develops suddenly, without any previous renal disease or any physical changes to the kidneys themselves. Your kidneys can be healthy, but they lose the capability to function because their blood supply has been ruined.

 

People with hepatorenal syndrome have constricted and narrowed blood vessels in their kidneys as a result of liver failure, which reduces flow of blood to the kidneys. This slowly slows down kidney functions. Hepatorenal syndrome requires urgent treatment, and in many cases, a liver transplant is the only solution.

 

Causes of liver and kidney issues   

Hepatorenal syndrome develops when the kidneys stop working properly in people with serious liver problems. Less urine is generated by the body, so waste products that carry nitrogen collected in the bloodstream (azotemia).

 

The disorder develops in up to 1 in 10 individuals who are hospitalized with liver failure. It causes kidney failure in people with:

 

• Acute liver failure

• Alcoholic hepatitis

• Infected abdominal fluid (peritonitis)

• Cirrhosis

 

Risk factors may include:

• Blood pressure that falls when an individual suddenly changes position or rises (orthostatic hypotension)

• Use of medicines known as diuretics (“water pills”)

• Recent removal of abdominal fluid (paracentesis)

• Infection

• Gastrointestinal bleeding

 

What are the signs and symptoms of hepatorenal syndrome?

People with liver and kidney issues experience symptoms of general unwellness, such as:

 

• Nausea

• Fatigue

• Bad taste in mouth

• Stomach ache

 

They may also experience signs of bad liver and kidney function or symptoms of liver failure or advanced liver disease, such as:

 

• Jaundice (yellowing of the white areas of the eyes)

• Easy bleeding and bruising

• Disorientation, confusion or drowsiness (hepatic encephalopathy)

• Dark-colored pee or light-colored poop

• Itchy skin

• Abdominals welling (due to enlarged liver, scites, or enlarged spleen)

 

Diagnosing liver and kidney issues or hepatorenal syndrome

Your doctor may first check if you have this condition during a physical examination. They look for signs of HRS such as:

 

• Swollen breast tissue

• Jaundice

• Sores on skin

• Buildupof fluid in the abdomen

 

HRS diagnosis means eliminating other causes of kidney failure. This needs a series of urine and blood tests. The tests will help your doctor determine your liver and kidney function. In rare cases, hepatorenal syndrome can develop in patients whose liver has been damaged by other causes than cirrhosis. If you don’t experience cirrhosis, your doctor may order further tests for alcoholic or viral hepatitis.

Treatment of liver and kidney disease

The only treatment that will treat hepatorenal syndrome is a liver transplant. This increases the chances of survival of a patient and can considerably reduce or even eliminate liver failure symptoms.

 

However, not all individuals are good candidates for transplants, and the list for transplant waiting is long. Some people may never get a liver transplant.

 

If an individual is not a candidate for a liver transplant, or if they are waiting for a transplant, a doctor can try various treatments to improve symptoms and extend their life:

 

• Stopping drugs that damage the kidneys

• Asurgery known as paracentesis is done for the removal of excess abdominal fluid

• Puttinga transjugular intrahepatic portosystemic shunt (TIPS) to lower stress and portal hypertension on the kidneys

• Atype of experimental dialysis called molecular adsorbent recirculating system

• Food and Drug Administration approved the drug terlipressin in 2022, to improve kidney functioning in people with liver and kidney issues

 

In a few cases, kidney failure will require an individual to have a kidney transplant besides a liver transplant.

 

Hepatorenal syndrome is a serious diagnosis that can be deadly.

 

The only cure for liver and kidney disease is a liver transplant, which is a very risky process for which not all people will be eligible. People who have done a liver transplant after liver failure may still have kidney damage. Hepatorenal syndrome also warns of a lower liver transplant success rate.

 

The type of hepatorenal syndrome also affects the outlook of a person. With type 1 hepatorenal syndrome, the outlook is commonly poor. Without a liver transplant, even after getting a treatment, survival of 2 years is less than 50%.

 

Preventing hepatorenal syndrome

The only way to prevent liver and kidney disease is to keep your liver healthy. To reduce the risk of developing cirrhosis, avoid taking excessive amounts of alcohol.

 

You should also try to avoid contracting hepatitis. Both hepatitis A and B can be prevented with the help of vaccination. Currently hepatitis C has no vaccine. Some steps you can take to prevent hepatitis C generally include:

 

• Wash your hands after shaking hands

• Not sharing your needles with someone else

• Always practice safe sex

• Haveyour sex partner get tested for hepatitis C

• Not taking illegal drugs

 

A few causes of cirrhosis can’t be prevented. If you’re at higher risk for developing cirrhosis, your healthcare provider may monitor your liver function regularly. They can also order imaging and blood tests to detect early signs of hepatorenal syndrome.

 

What are the chances of surviving liver and kidney Failure?

The chances of surviving liver and kidney failure vary from person to person. However, most patients die within some weeks of the onset of kidney failure without treatment. In fact, 50% of patients die within 2 weeks of diagnosis and 80% of patients die within 3 months of diagnosis.

 

Summary

Hepatorenal syndrome is a fatal medical condition that occurs in people who have serious liver disease. It commonly requires a hospital stay and rapid medication to save the life of a person.

 

Though a few treatments may prolong a person’s life, the only treatment that will treat hepatorenal syndrome is a liver transplant.

 

People with liver and issues should talk with their doctor regarding options for improving liver and kidney function to reduce the risk of hepatorenal syndrome.

 

Managing liver issues and risk factors, like reducing alcohol intake, can lower  a person’s lifetime risk of both hepatorenal syndrome and liver disease.