saudigastro.com/patients/hepatorenal-syndrome
Category
Serious
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
If you have cirrhosis and your urine drops sharply, you feel confused or very sleepy, or your abdomen or legs swell quickly, go to the emergency department now. Hepatorenal syndrome (HRS) is kidney failure that happens in people with severe liver disease, usually cirrhosis with fluid in the abdomen (ascites). The kidneys themselves are structurally healthy, but they stop working because of changes in blood flow caused by the liver disease. It is a hospital emergency. There is no home treatment.
How common is it?
It happens mainly in people with advanced cirrhosis and ascites, and sometimes in acute severe liver injury. It is more likely after infections, bleeding, or loss of fluid from vomiting, diarrhea or too much diuretic treatment.
Why does it happen?
In advanced liver disease, blood vessels in the gut widen, which lowers the effective blood flow to the kidneys. The body responds by tightening kidney vessels, and the kidneys shut down their filtering. Triggers include infection (especially of the abdominal fluid), gastrointestinal bleeding, large-volume fluid removal without replacement, dehydration, and certain medicines such as anti-inflammatory painkillers.
Symptoms
- Passing much less urine than usual
- Rapid weight gain and increasing swelling of the abdomen or legs
- Marked tiredness, drowsiness or confusion
- Nausea and loss of appetite
- Worsening jaundice
- Dry mouth and thirst
Red flags — seek urgent medical care
Very little or no urine for many hours
The kidneys may be failing. Go to the emergency department now.
Confusion, extreme sleepiness or difficulty waking
Brain effect of liver or kidney failure. Call emergency services.
Fever, abdominal pain or tenderness
Possible infection of ascitic fluid, a common trigger. Seek emergency care.
Vomiting blood or black stools
Gut bleeding can trigger kidney failure. Go to the emergency department immediately.
Persistent vomiting or diarrhea in someone on water tablets
Dehydration can harm the kidneys. Contact your doctor urgently and do not take your water tablets until advised.
How is it diagnosed?
Doctors diagnose HRS by excluding other causes of kidney injury. They check blood creatinine (a kidney marker) and urine tests, look for infection, bleeding or medicines that harm the kidneys, and stop diuretics and certain drugs. Fluid is given into a vein (often with albumin, a protein solution) to see if kidney function improves; if it does not, and no other cause is found, HRS is diagnosed. An ultrasound of the kidneys is done.
Outlook — what to expect
HRS is serious. Treatment in hospital can improve kidney function in some people, but because it signals advanced liver disease, the long-term outlook depends mostly on the liver. Liver transplant is the definitive treatment for suitable patients. Your care team will discuss the options honestly with you and your family.
Treatment
Habits & Lifestyle
There is no home treatment for hepatorenal syndrome; it needs hospital care. These steps help reduce the risk.
- Go to hospital early for any infection, bleeding, vomiting or diarrhea if you have cirrhosis
- Do not take anti-inflammatory painkillers (such as ibuprofen or diclofenac) unless your doctor allows
- Weigh yourself regularly and report fast weight changes or reduced urine
- Avoid alcohol completely
- Keep every follow-up appointment for cirrhosis
Diet
Diet and fluids in cirrhosis should follow your liver team's advice, which may change during illness.
- Follow the salt limit your doctor gave you
- Do not restrict or force fluids unless told; the team will decide in hospital
- Keep eating enough protein and calories; malnutrition worsens outcomes
- Avoid raw shellfish and unsafe food that may cause infection
Medications
Treatment is given in hospital by a liver and kidney team.
- Stopping water tablets and other medicines that can harm the kidneys
- Albumin given into a vein
- Medicines that tighten blood vessels (vasoconstrictors) given in hospital, under close monitoring
- Treating infection and bleeding that triggered the problem
Procedures & Surgery
Some patients need procedures or organ support.
- Careful drainage of ascites with albumin replacement when needed
- Kidney dialysis as a bridge in selected patients, particularly those who may receive a transplant
- Liver transplant (sometimes with kidney transplant) is the definitive treatment in suitable patients
- A procedure to reduce pressure in the portal vein (TIPS) is used only in carefully selected patients
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What triggered the kidney problem?
- Which treatments are being used and how will we know they are working?
- Am I a candidate for liver transplant assessment?
- Which medicines should I avoid in the future?
- What warning signs should my family watch for at home?
Was this guide helpful?
Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide