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Hepatorenal Syndrome Clinical Presentation

  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
Updated: Jan 13, 2016


Most individuals with cirrhosis who develop hepatorenal syndrome (HRS) have nonspecific symptoms, such as fatigue, malaise, or dysgeusia. Development of HRS is usually noticed when patients observe decreased urine output and when blood test results show a decline in renal function.


Physical Examination

Hepatorenal syndrome (HRS) has no specific signs. However, detecting stigmata of chronic liver disease is important because most patients at risk for HRS have cirrhosis. The following list of physical findings is not all-inclusive, and these findings are not present in all patients with chronic liver disease.

The hands may exhibit the following:

  • Palmar erythema
  • Leuconychia
  • Muscle wasting
  • Asterixis
  • Clubbing

Head, ears, nose, throat examination may reveal the following:

  • Scleral icterus
  • Spider nevi (usually confined to the drainage area of the superior vena cava)
  • Fetor hepaticus
  • Xanthelasma

Chest findings may include gynecomastia.

Abdominal findings may include the following:

  • Caput medusae
  • Hepatosplenomegaly
  • Ascites
  • Paraumbilical hernia
  • Bruits

The genitalia may show loss of pubic hair/secondary sexual characteristics in men and/or atrophic testes.

The extremities may exhibit muscle wasting, peripheral edema, and/or clubbing.

Contributor Information and Disclosures

Deepika Devuni, MBBS Resident Physician, Department of Internal Medicine, University Of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Ann Ouyang, MBBS Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.


Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Hemant K Roy, MD Associate Professor of Medicine, Section of Gastroenterology, Feinberg School of Medicine at Northwestern University, Evanston-Northwestern Healthcare

Disclosure: Nothing to disclose.

Rowen K Zetterman, MD Director, Faculty Mentoring Programs, University of Nebraska Medical Center; Dean Emeritus, Creighton University School of Medicine

Rowen K Zetterman, MD, is a member of the following medical societies: Alpha Omega Alpha, American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

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