Hepatorenal syndrome

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Male urinary system

• Abdominal swelling due to fluid (called ascites, a symptom of the underlying liver disease)
• Change in mental status
  • Confusion
  • Delirium
  • Dementia
• Coarse muscle movements or mucle jerks
• Dark-colored urine (a symptom of the underlying liver disease)
• Decreased urine production
• Nausea and vomiting
• Weight gain
• Yellow skin (jaundice, a symptom of the underlying liver disease)

This condition is diagnosed when other causes of kidney failure are ruled out by the appropriate tests.

A physical examination does not directly reveal kidney failure. However, the exam will usually show signs of chronic liver disease:

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• Confusion (often due due to hepatic encephalopathy)
• Excess fluid in the abdomen (ascites)
• Jaundice
• Other signs of liver failure

Other signs include:

• Abnormal reflexes
• Decreased testicle size
• Dull sound in the abdomen when tapped with the tips of the fingers, and visible fluid wave when examined by feel
• Increased breast tissue (gynecomastia)
• Sores (lesions) on the skin

The following may be signs of kidney failure:

• Absent or low urine production, less than 400 cc/day
• Fluid retention in the abdomen or extremities
• Increased BUN and serum creatinine levels
• Increased urine specific gravity and osmolality
• Low serum sodium
• Very low urine sodium concentration

The following may be signs of liver failure:

• Abnormal prothrombin time (PT)
• Increased serum ammonia levels
• Low serum albumin
• Paracentesis shows ascites
• Signs of hepatic encephalopathy (an EEG may be performed if such signs are present)

Review Date: 05/04/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).