Hepatorenal syndrome differential diagnosis

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

Overview

Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. 

Differentiating Hepatorenal Syndrome from other Diseases

Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:

Variables	Kidney injury associated with infection	Prerenal acute kidney injury	Hepatorenal syndrome	Parenchymal renal disease
Mechanism Causes	Infections, including SBP	Hypovolumia due: gastrointestinal fluid losses bleeding diuretic non-steroidal anti-inflammatory drug	Splanic vasodalation due to nitic oxide	Aminoglycoside therapy Radiocontrast agent Sepsis
Diagnostic clue	History of fever Blood cultures Ascetic cultures	History of: Bleeding Low blood pressure Intake of NSAID	Diagnosis of exclusion: Liver failure + Renal failure no apparent cause for the acute kidney injury No improvement on removing nephrotoxic agent repleating fluid loss	History of: Infections Injection of Dye intake of nephrotoxic agent
Prognosis	Good	Good	Poor	Good