Hepatorenal syndrome (HRS) is a multiorgan disease that affects the kidneys and liver. It is a cause of acute kidney injury (AKI) that can be seen in patients suffering from acute or chronic liver disease. The first association of renal failure in cirrhosis was reported during the 1800s. Our study aims to determine the risk factors associated with HRS-AKI in cirrhotic patients to guide clinicians in determining the risk of development of HRS-AKI. Objectives are to know the relation between age, gender, Body Mass Index (BMI), creatinine, Model for End Stage Liver Disease (MELD) scores, history of ascites, ventilation, duration of hospitalization, haemodialysis requirements, presence of any infection, mortality rate with the development of HRS. The study was conducted in the Nephrology Department at a tertiary care centre named NRI. Medical College, Chinakakani, Andhra Pradesh, India, on 100 patients admitted in the nephrology department. Males and females above 18 years, admitted with cirrhosis and AKI, were included in the study. Results showed that among 100 admitted patients, the incidence of HRS was 12%. There was a significant difference in the mean serum creatinine, haemoglobin, and bilirubin levels between cases and controls. The mean duration of hospitalization, death rate, and need for mechanical ventilation were significantly more among cases compared to controls. We conclude that the prevalence of hepatorenal syndrome is high among patients with cirrhosis and AKI.

1. Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020;370:m2687. doi: 10.1136/bmj.m2687, PMID 32928750.
2. Sivanathan V, Kittner JM, Sprinzl MF, Weinmann A, Koch S, Wiltink J, et al. Etiology and complications of liver cirrhosis: data from a German centre. Dtsch Med Wochenschr. 2014 Sep;139(36):1758-62. doi: 10.1055/s-0034-1387240, PMID 25157862.
3. Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal syndrome. Clin Biochem Rev. 2007 Feb;28(1):11-7. (PMC Free article). PMID 17603637.
4. Terra C, Mattos ÂZ, Pereira G, Farias AQ, Kondo M, Mattos AA et al. Recommendations of the Brazilian society of hepatology for the management of acute kidney injury in patients with cirrhosis. Arq Gastroenterol. 2018 Jul-Sep;55(3):314-20. doi: 10.1590/S0004-2803.201800000-71, PMID 30540097.
5. Amin AA, Alabsawy EI, Jalan R, Davenport A. Epidemiology, pathophysiology, and management of hepatorenal syndrome. Semin Nephrol. 2019 Jan;39(1):17-30. doi: 10.1016/j.semnephrol.2018.10.002, PMID 30606404.
6. Allegretti AS, Ortiz G, Wenger J, Deferio JJ, Wibecan J, Kalim S et al. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: A prospective cohort study. Int J Nephrol. 2015;2015:108139. doi: 10.1155/2015/108139, PMID 26266048.
7. Cholongitas E, Senzolo M, Patch D, Shaw S, O’Beirne J, Burroughs AK. Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality. Eur J Gastroenterol Hepatol. 2009;21(7):744-50. doi: 10.1097/MEG.0b013e328308bb9c, PMID 20160527.
8. Terra C, Guevara M, Torre A, Gilabert R, Fernández J, Martín-Llahí M; et al. Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: value of MELD score. Gastroenterology. 2005;129(6):1944-53. doi: 10.1053/j.gastro.2005.09.024, PMID 16344063.
9. Thabut D, Massard J, Gangloff A, Carbonell N, Francoz C, Nguyen-Khac E, et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure. Hepatology. 2007;46(6):1872-82. doi: 10.1002/hep.21920, PMID 17972337.
10. Acevedo JG, Cramp ME. Hepatorenal syndrome: update on diagnosis and therapy. World J Hepatol. 2017;9(6):293-9. doi: 10.4254/wjh.v9.i6.293, PMID 28293378.
11. Ojeda-Yuren AS, Cerda-Reyes E, Herrero-Maceda MR, Castro-Narro G, Piano S. An integrated review of the hepatorenal syndrome. Ann Hepatol. 2021;22:100236. doi: 10.1016/j.aohep.2020.07.008, PMID 32846202.
12. Allegretti AS, Ortiz G, Wenger J, Deferio JJ, Wibecan J, Kalim S, et al. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: a prospective cohort study. Int J Nephrol. 2015;2015:108139. (PMC Free article). doi: 10.1155/2015/108139, PMID 26266048.
13. Ruiz?del?Arbol L, Monescillo A, Arocena C, Valer P, Ginès P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005;42(2):439-47. doi: 10.1002/hep.20766, PMID 15977202,
14. Arroyo V, Guevara M, Ginès P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology. 2002;122(6):1658-76. doi: 10.1053/gast.2002.33575, PMID 12016430.
15. Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41(6):1282-9. doi: 10.1002/hep.20687, PMID 15834937.
16. Gilbertson EL, Krishnasamy R, Foote C, Kennard AL, Jardine MJ, Gray NA. Burden of care and quality of life among caregivers for adults receiving maintenance dialysis: a systematic Review. Am J Kidney Dis. 2019;73(3):332-43. doi: 10.1053/j.ajkd.2018.09.006, PMID 30454885.
17. Jamil K, Huang X, Lovelace B, Pham AT, Lodaya K, Wan G. The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records. J Med Econ. 2019;22(5):421-9. doi: 10.1080/13696998.2019.1580201, PMID 30724682.
18. Fida S, Khurshid SMS, Mansoor H. Frequency of hepatorenal syndrome among patients with cirrhosis and outcome after treatment. Cureus. 2020 Aug 25;12(8):e10016. doi: 10.7759/cureus.10016, PMID 32983712, PMCID PMC7515548.
19. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84. doi: 10.1159/000339789, PMID 22890468.
20. Pan HC, Chien YS, Jenq CC, Tsai MH, Fan PC, Chang CH; et al. Acute kidney injury classification for critically ill cirrhotic patients: A comparison of the KDIGO, AKIN, and RIFLE classifications. Sci Rep. 2016;6:23022. doi: 10.1038/srep23022, PMID 26983372.
21. Ginès A, Escorsell A, Ginès P, Saló J, Jiménez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105(1):229-36. doi: 10.1016/0016-5085(93)90031-7, PMID 8514039.
22. Janicko M, Veseliny E, Senajova G, Jarcuska P. Predictors of hepatorenal syndrome in alcoholic liver cirrhosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(4):661-5. doi: 10.5507/bp.2015.010, PMID 25820623 [CrossRef], .
23. Angeli P, Garcia-Tsao G, Nadim MK, Parikh CR. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019;71(4):811-22. doi: 10.1016/j.jhep.2019.07.002, PMID 31302175.
24. Rey RM, Delgado AF, De Zubiria A, Pinto R, De la Hoz-Valle JA, Pérez-Riveros ED et al. Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia. PLOS ONE. 2020;15(10):e0239834. doi: 10.1371/journal.pone.0239834. (PMC Free article). PMID 33079947.
25. Jani?ko M, Veselíny E, Abraldes JG, Jar?uška P. Serum sodium identifies patients with cirrhosis at high risk of hepatorenal syndrome. Z Gastroenterol. 2013;51(7):628-34. doi: 10.1055/s-0032-1330676, PMID 23696114.
26. Mohanty A, Garcia-Tsao G. Hyponatremia and hepatorenal syndrome. Gastroenterol Hepatol (N Y). 2015;11(4):220-9. (PMC Free article). PMID 27099594.
27. Naveh Y, Finberg JP, Kahana L, Better OS. Renin-angiotensin system in dogs following chronic bile-duct ligation. Relation to vascular reactivity. J Hepatol. 1988;6(1):57-62. doi: 10.1016/S0168-8278(88)80462-8, PMID 3279106.
28. Bomzon A, Rosenberg M, Gali D, Binah O, Mordechovitz D, Better OS et al. Systemic hypotension and decreased pressor response in dogs with chronic bile duct ligation. Hepatology. 1986;6(4):595-600. doi: 10.1002/hep.1840060408, PMID 3732994.
29. van Slambrouck CM, Salem F, Meehan SM, Chang A. Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction. Kidney Int. 2013;84(1):192-7. doi: 10.1038/ki.2013.78, PMID 23486516.
30. Bräsen JH, Mederacke YS, Schmitz J, Diahovets K, Khalifa A, Hartleben B, et al. Cholemic nephropathy causes acute kidney injury and is accompanied by loss of aquaporin 2 in collecting ducts. Hepatology. 2019;69(5):2107-19. doi: 10.1002/hep.30499, PMID 30633816.
31. Nazar A, Pereira GH, Guevara M, Martín-Llahi M, Pepin MN, Marinelli M, et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2010;51(1):219-26. doi: 10.1002/hep.23283, PMID 19877168.
32. Bashir MH, Iqbal S, Miller R, Singh J, Mubarak G, Likhtshteyn M, et al. Management and outcomes of hepatorenal syndrome at an urban academic medical center: A retrospective study. Eur J Gastroenterol Hepatol. 2019;31(12):1545-9. doi: 10.1097/MEG.0000000000001462, PMID 31169567.
33. Belcher JM, Garcia-Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology. 2013;57(2):753-62. doi: 10.1002/hep.25735. (PMC Free article). PMID 22454364.
34. Nazar A, Pereira GH, Guevara M, Martín-Llahi M, Pepin MN, Marinelli M; et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2010;51(1):219-26. doi: 10.1002/hep.23283, PMID 19877168.
35. Ginès P, Solà E, Angeli P, Wong F, Nadim MK, Kamath PS. Hepatorenal syndrome. Nat Rev Dis Primers. 2018;4(1):23. doi: 10.1038/s41572-018-0022-7, PMID 30213943.
36. Flamm SL, Brown K, Wadei HM, Brown RS, Jr., Kugelmas M, Samaniego-Picota M et al. The current management of hepatorenal syndrome-acute kidney injury in the United States and the potential of terlipressin. Liver Transpl. 2021;27(8):1191-202. doi: 10.1002/lt.26072, PMID 33848394.