Hepatorenal Syndrome Clinical Presentation

Updated: Sep 22, 2022
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Most individuals with cirrhosis who develop hepatorenal syndrome (HRS) have nonspecific symptoms, such as fatigue, malaise, or dysgeusia (altered sense of taste). Development of HRS is usually noticed when patients observe decreased urine output and when blood test results show a decline in renal function. Although type 2 HRS is typically spontaneous, type 1 (now known as HRS-acute kidney injury [AKI]) may be precipitated by infection (such as bacterial or viral hepatitis), excessive response to diuretics, use of alcohol and drugs, or large-volume paracentesis without administration of albumin.


Physical Examination

Hepatorenal syndrome (HRS) has no specific signs. However, detecting the 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 (white nails)

  • Muscle wasting

  • Asterixis (flapping tremors)

  • 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 (strong musty smell)

  • 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.