Main Article Content

Abdul Qadir
Adam Khan
Basit Ali
Mohammad Umar
Muhammad Talha
Aamer Ahmad
Faizan Banaras


Hepatorenal syndrome, Cirrhosis, Ascites, Predictive factors


Background and Aim: Renal failure, especially in its acute phase, is common in patients with liver cirrhosis and ascites. The incidence of hepatorenal syndrome varies from 18% to 39% in a span of 1 to 5 years.  The present study aimed to determine the prevalence, predictive factors, and prognosis of hepatorenal syndrome (HRS) in cirrhosis with ascites.

Patients and Methods: This prospective study was carried out on 68 cirrhotic patients admitted for the treatment of ascites in the Departments of Nephrology and Gastroenterology, Khyber Teaching Hospital, Peshawar from January 2022 to December 2022. The median GFR, median values of serum sodium, and urine sodium concentrations were measured for each individual. All the patients underwent physical examination and detailed history. The abdominal tapped fluid was used to measure the concentration of protein ascetic fluid. Descriptive statistics were done in SPSS version 27.

Results: Of the total patients, there were 46 male and 22 females. The overall mean age was 48.64±4.8 years. Out of 68 patients, the incidence of cryptogenic cirrhosis and hepatitis B surface antigen (HBsAg)-positive cirrhosis was 76.5% (n=52) and 23.5% (n=16) respectively. Based on physical examination, the incidence of hepatomegaly, splenomegaly, and hepatic stigmata was 57.4% (n=39), 38.2% (n=26), and 79.4% (n=54) respectively. About 58.8% (n=40) patients had previous episodes of ascites. Gastrointestinal hemorrhage and hepatic encephalopathy was found in 26.5% (n=18) and 19.1% (n=13) respectively. Serum bilirubin levels increased in majority of patients 76.5% whereas serum albumin concentration decreased in 85.3% cases.

Conclusion: The present study found that HRS is a comparatively common complication in cirrhosis patients with ascites that is significantly associated with higher mortality rate and short survival rate. Hepatorenal syndrome could be easily predicted by plasma renin activity, liver size, and concentration of serum sodium.

Abstract 399 | pdf Downloads 131


1. El Sharawy SM, Elkadeem MZ, Amer IF. The Predictors of Hepatorenal Syndrome Development in HCV Cirrhotic Ascitic Egyptian Patients with Spontaneous Bacterial Peritonitis. Anti-inflammatory & anti-allergy agents in medicinal chemistry.
2. Habas E, Ibrahim AR, Moursi MO, Shraim BA, Elgamal ME, Elzouki AN. Update on hepatorenal Syndrome: Definition, Pathogenesis, and management. Arab Journal of Gastroenterology. 2022 May 1;23(2):125-33.
3. Chinnasamy V, Dhande SK, Kumar KM. Precipitating Factors and Outcome of Hepatorenal Syndrome in Liver Cirrhosis. The Journal of the Association of Physicians of India. 2022 Dec 1;71(1):1-.
4. Rahman SA, Venkatraman S. Role of Cystatin C as A Novel Biomarker in Predicting the Incidence of Hepatorenal Syndrome in Liver Cirrhosis Patients with Normal Serum Creatinine Levels. European Journal of Cardiovascular Medicine. 2022 Jan 1;13(1).
5. Zheng X, Lian Y, Wang P, Zheng L, Wu H, Lin J, Chen X, Gao Z, Peng L, Xie C. Mean arterial pressure drop is an independent risk factor of hepatorenal syndrome in patients with HBV-ACLF. European journal of gastroenterology & hepatology. 2022 May;34(5):576.
6. Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther 2017; 45:593–603.
7. Zhang J, Rössle M, Zhou X, Deng J, Liu L, Qi X. Terlipressin for the treatment of hepatorenal syndrome: an overview of current evidence. Curr Med Res Opin 2019; 35:859–868.
8. Boyer TD, Sanyal AJ, Garcia-Tsao G, Blei A, Carl D, Bexon AS, Teuber P; Terlipressin Study Group. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol 2011; 55:315–321.
9. Salerno F, Navickis RJ, Wilkes MM. Albumin treatment regimen for type 1 hepatorenal syndrome: a dose-response meta-analysis. BMC Gastroenterol 2015; 15:167.
10. Ghosh S, Choudhary NS, Sharma AK, Singh B, Kumar P, Agarwal R, et al. Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study. Liver Int 2013; 33:1187–1193.
11. Kalambokis GN, Tsiakas I, Christaki M, Koustousi C, Christou L, Baltayiannis G, Christodoulou D. Systemic hemodynamic response to terlipressin predicts development of hepatorenal syndrome and survival in advanced cirrhosis. Eur J Gastroenterol Hepatol 2018; 30:659–667.
12. Maddukuri G, Cai CX, Munigala S, Mohammadi F, Zhang Z. Targeting an early and substantial increase in mean arterial pressure is critical in the management of type 1 hepatorenal syndrome: a combined retrospective and pilot study. Dig Dis Sci 2014; 59:471–481.
13. Boyer TD, Sanyal AJ, Wong F, Todd Frederick R, Lake JR, O'Leary JG, et al. Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1. Gastroenterology 2016; 150:1579–1589.e1572.
14. Sridharan K, Sivaramakrishnan G. Vasoactive agents for hepatorenal syndrome: a mixed treatment comparison network meta-analysis and trial sequential analysis of randomized clinical trials. J Gen Intern Med 2018; 33:97–102.
15. Rajekar H, Chawla Y. Terlipressin in hepatorenal syndrome: Evidence for present indications: Terlipressin in hepatorenal syndrome. J Gastroenterol Hepatol. 2011; 26: 109–114.
16. Kazory A, Ronco C. Hepatorenal Syndrome or Hepatocardiorenal Syndrome: Revisiting Basic Concepts in View of Emerging Data. Cardiorenal Med. 2019; 9: 1–7.
17. Ginès A, Escorsell A, Ginès P, Salo´ J, Jime´nez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993; 105: 229–236.
18. Martı ´n–Llahı ´ M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, et al. Prognostic Importance of the Cause of Renal Failure in Patients With Cirrhosis. Gastroenterology. 2011; 140: 488–496.e4.
19. Wadei H. Hepatorenal Syndrome: A Critical Update. Semin Respir Crit Care Med. 2012; 33: 55–69.
20. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis: Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996; 23: 164–176.
21. Wang H, Liu A, Bo W, Feng X, Hu Y. Terlipressin in the treatment of hepatorenal syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97: e0431.
22. Shah N, Silva RG, Kowalski A, Desai C, Lerma E. Hepatorenal syndrome. Dis Mon. 2016; 62: 364–375.
23. Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015; 64: 531–537.
24. Fagundes C, Guevara M, Martı ´n-Lhahı ´ M, Sola E, Pereira GH, Garcı ´a-Lo´pez E, et al. Hepatorenal Syndrome Associated with Bacterial Infections in Cirrhosis. Prognostic relevance and importance of circulatory dysfunction. J Hepatol. 2011; 54: S380.
25. Ca´rdenas A. Renal failure after upper gastrointestinal bleeding in cirrhosis: Incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001; 34: 671–676.
26. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010; 53: 397–417.
27. Salerno F, Cazzaniga M, Merli M, Spinzi G, Saibeni S, Salmi A, et al. Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice. J Hepatol. 2011; 55: 1241–1248.
28. Rodriguez E, Henrique Pereira G, Solà E, Elia C, Barreto R, Pose E, et al. Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes: Treatment of Type 2 HRS and LT. Liver Transpl. 2015; 21: 1347–1354.
29. Dobre M, Demirjian S, Sehgal AR, Navaneethan SD. Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis. Int Urol Nephrol. 2011; 43: 175–184.
30. Amin AA, Alabsawy EI, Jalan R, Davenport A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin Nephrol. 2019; 39: 17–30.

Most read articles by the same author(s)