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Hepatorenal syndrome (HRS) is a functional, potentially reversible form of renal failure that occurs in patients with advanced cirrhosis, acute liver failure, or severe alcoholic hepatitis, due to profound circulatory changes.

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• Kidneys are structurally normal, but renal hypoperfusion occurs from splanchnic vasodilatation, decreased effective arterial volume, and renal vasoconstriction.

https://www.youtube.com/watch?v=UMd6c9vxdro

https://www.youtube.com/watch?v=Bb3S85BmZAg

https://www.youtube.com/watch?v=O8kOuXRmNFc

Etiopathogenesis

• Portal hypertension → splanchnic vasodilation (via NO, prostaglandins, glucagon).
• Reduced effective arterial blood volume → activates RAAS, sympathetic nervous system, ADH.
• Leads to renal vasoconstriction and ↓ GFR.
• Kidneys structurally intact, but functionally suppressed.

Risk factors:

• Advanced cirrhosis with ascites.
• Spontaneous bacterial peritonitis (SBP).
• GI bleeding, overdiuresis, large-volume paracentesis without albumin.

Clasification

ICA 2015 definition – International Club of Ascites

1. HRS–AKI (previously Type I HRS)

• Acute rise in serum creatinine (≥0.3 mg/dL in 48 hrs or ≥50% from baseline in <7 days).