Hepatorenal syndrome (HRS), a type of kidney failure: Causes, symptoms, and treatment

Hepatorenal syndrome (HRS), a type of kidney failure: Causes, symptoms, and treatmentHepatorenal syndrome (HRS) is a type of kidney failure that occurs in patients with severe liver problems. There are two types of HRS. Type 1 is associated with accelerated kidney failure and type 2 is associated with a more gradual kidney failure. Type 1 HRS is characterized by an overproduction of creatinine. In type 2, the disease progression is slower and symptoms may be subtle. HRS is almost always fatal, so it should always be approached as a medical emergency.

Causes, risk factors, and complications of HRS

HRS is always a complication of liver disease most commonly caused by cirrhosis of the liver. If you already have liver cirrhosis, there are other risk factors that can increase your odds of developing HRS, namely, unstable blood pressure, use of diuretics, acute alcoholic hepatitis, gastrointestinal bleeding, spontaneous bacterial peritonitis, and other infections (especially those affecting kidneys).


As mentioned, HRS is almost always fatal, but undergoing a liver transplant can extend your life. Complications from HRS often occur in late-stage kidney disease and can include fluid overload, secondary infections, organ damage, and coma.

Symptoms of hepatorenal syndrome

As soon as the symptoms appear a patient should seek medical attention right away to prevent complications and death. Symptoms of HRS include:

  • Confusion
  • Delirium
  • Nausea
  • Vomiting
  • Dementia
  • Weight gain
  • Jaundice
  • Decreased urine output
  • Swollen abdomen

Diagnosing hepatorenal syndrome

Your doctor will look for HRS signs such as swollen breast tissue, sores on the skin, fluid buildup in the abdomen, and jaundice when diagnosing HRS. Your doctor will also rule out other causes of kidney problems by running a series of blood and urine tests.

If an HRS patient doesn’t have liver cirrhosis, the doctor may run other tests to check for viral or alcoholic hepatitis.

Treating and preventing HRS

Vasoconstricting medications are used to treat HRS as they treat low blood pressure. Dialysis is also beneficial as it can help improve kidney symptoms. Dialysis benefits kidney disease patients by helping filter waste, along with excess salt and water, from the blood.

The most effective way to treat HRS is with a liver transplant, but unfortunately waiting list for such surgeries is quite long.

To best prevent HRS, you would need to protect your liver from disease and infection. This involves reducing alcohol intake, maintaining a healthy weight, preventing hepatitis infection, practicing safe sex, not sharing needles, not using illegal drugs, and always washing your hands.

Hepatorenal syndrome diet

The goal of an HRS diet is to protect both the kidneys and the liver. Researchers looked at 71 patients with hypertensive stage 4 kidney disease who received fruits and vegetables or an oral alkaline medication for one year.

Researcher Donald Wesson explained, “We showed that by addition of alkali such as bicarbonate or alkali-inducing fruits and vegetables, patients had a favorable response by reduction of urinary kidney injury markers. Our study suggests that these interventions will help maintain kidney health in those with kidney disease.”

Other dietary changes include limiting animal proteins, limiting sodium, and limiting fluid intake as your body may retain fluid.

Foods you should eat with kidney failure include starches such as bread, cereal, rice, pasta, popcorn, and unsalted crackers, vegetables that are low or medium in potassium like bean sprouts, eggplant, lettuce, asparagus, celery, and mixed vegetables, fruits with low to medium potassium content like grapes, pears, peaches, mangos, and blueberries, as well as dairy and small amounts of protein including beef, pork, poultry, and eggs.


Fats like butter, margarine, or oil should be limited to either one teaspoon or one tablespoon a day.

Your doctor will be able to give you a full list of foods you should eat while treating hepatorenal syndrome.

Related: Renal diet: Foods to eat and avoid for kidney failure

Author Bio

Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.


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