Hepatorenal syndrome classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

The classification of hepatorenal syndrome is based on the deteriorating function of kidney in to two types: type 1 rapidly progressive and type 2 HRS, slowly progressive.

Classification

The hepatorenal syndrome is defined as renal failure that occurs in the setting of liver disease as follows:

Type I HRS

Type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 221 μmol/L (2.5 mg/dL) or a halving of the creatinine clearance to less than 20 mL/min over a period of less than 2 weeks.

Type II HRS

Type II HRS is characterized by a slowly progressive:

  • Increase in serum creatinine level to greater than 133 μmol/L (1.5 mg/dL) or a creatinine clearance of less than 40 mL/min.
  • Urine sodium < 10 meq/dl. [1]

Classification on basis of mechanism of kidney injury in presence of liver failure:

  1. Hypovoluemia induced kidney injury: It occurs due to loss of fluid through GIT or GI bleed in presence of liver failure which predisposed kidney to hypovolumic injury.
  2. Parencheymal renal disease: In presence proteinuria above 500 mg/dl and hematuria above 50 red cells points to kidney injury primarily otherwise it points to liver damage promoting kidney injury.
  3. Drug induced hepato-nephrotoxicity: When drugs like acetaminophen and anti microbial causing hepatotoxicity and nephrotoxicity are taken together they can also produce combed damage.

References

  1. Ginés P, Arroyo V, Quintero E; et al. (1987). "Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study". Gastroenterology. 93 (2): 234–41. PMID 3297907.

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