Hepatorenal syndrome (HRS) causes kidney failure in people with severe liver disease. It happens when liver disease affects the blood vessels in your kidneys, causing them to stop working. HRS gets worse in a matter of weeks to months. The only cure is a liver transplant.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Hepatorenal syndrome (HRS) is a life-threatening complication of end-stage liver disease. In hepatorenal syndrome, liver failure causes blood vessels in your kidneys to narrow or constrict so blood can’t move through them. Your kidneys stop working because they don’t get enough blood, leading to kidney failure.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
If you have HRS, you’ll need immediate medical care. In most cases, a liver transplant is the only cure.
If you have HRS, you may have vague symptoms of general unwellness, such as:
You may also have symptoms of advanced liver disease or liver failure, like:
When kidney failure becomes severe, you’ll pee less than usual.
Experts are still researching the exact cause. They believe a mix of factors related to liver disease and liver failure causes blood vessels in your kidneys to narrow.
The most common risk factor is portal hypertension. Portal hypertension is high blood pressure in the portal vein that runs through your liver. It widens the vein and its branches throughout your digestive system.
Other conditions that may increase your risk of HRS include:
Hepatorenal syndrome typically affects people who’ve had chronic liver disease and are close to having liver failure. Chronic liver disease scars your liver (cirrhosis). This affects your liver’s blood supply and gradually stops it from working properly. HRS can also occur with acute liver failure from a sudden cause.
Advertisement
Studies suggest that up to 4 in 10 people with end-stage liver disease will develop HRS. They’re typically in the second half of their lives. Up to 1 in 10 people hospitalized with chronic or acute liver failure will develop it.
First, a healthcare provider will confirm that you have liver disease and kidney failure. Then, they’ll do tests to rule out other possible causes of kidney failure. They’ll order a variety of imaging, and blood and pee tests to check your liver function and kidney function.
Treatment for hepatorenal syndrome starts with caring for your kidneys. Treatments may include:
These treatments may help improve your overall health and make you fitter for a liver transplant. They may also improve your outcome if you do have a transplant.
The ultimate treatment is a transplant to replace your damaged liver. But finding a donor liver can be easier said than done. There are more people waiting for a liver transplant than there are available donor livers.
Your best chance may be finding a living liver donor. Living donors are healthy volunteers whose blood type and body size are like yours. A sliver of another living person’s liver can grow back into a full-sized liver. These livers are often in better condition than those from a deceased donor.
What you can expect depends on whether you can have a liver transplant.
If you’re already very sick with HRS, you may not be well enough to have a liver transplant. But studies show 6 in 10 people with HRS who have a liver transplant are alive three years later. Most people’s kidneys start working again. Some may need ongoing dialysis.
The median survival rate for people with acute onset HRS and no transplant is two weeks. “Acute onset” means your symptoms come on very fast. With chronic HRS, the median survival rate without a transplant is three to six months.
Ask your healthcare provider what to expect in your specific situation.
If you have end-stage liver disease, a diagnosis of hepatorenal syndrome (HRS) turns your chronic condition into a medical emergency. That’s probably very hard news to hear. And you may feel like you don’t have control over your outcome while you wait for a donor liver.
Advertisement
Your healthcare team will help you manage these emotions, so don’t hesitate to share what you’re feeling. They’ll answer your questions the best they can and keep you updated on treatment.
Advertisement
Sign up for our Health Essentials emails for expert guidance on nutrition, fitness, sleep, skin care and more.
Learn more about the Health Library and our editorial process.
Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.
Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.
If you have a disease that’s affecting your liver, you want expert advice and care. At Cleveland Clinic, we’ll create a treatment plan that’s right for you.
