Hepatorenal Syndrome

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.

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.

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.

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 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

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

Doses and choice of medicines are set by the hospital team.

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

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.

• 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?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.