Hepatorenal Syndrome




  1. Correct hypovolemia
  2. Manage emergency consequences of renal failure: 
  3. DC potential nephrotoxins: 
  4. Correct electrolyte imbalances
  5. Broad-spectrum antibiotics if sepsis suspected
  6. Correct liver-associated complications: 
  7. Large volume paracentesis w/IV albumin replacement
  8. Dialysis (in pts awaiting liver transplant, fulminant liver failure, coexisting renal dz, azotemia-induced hepatic encephalopathy, and acute renal failure of unknown etiology)
  9. Renal dose dopamine: 2 mcg/kg/min
  10. Midodrine 7.5 - 12.5 mg PO tid plus Octreotide 100-200 mcg SQ tid; or
  11. Norepinephrine 0.5-3 mg/hr infusion


  1. Admit all pts suspected of having hepatorenal syndrome with GI and nephrologist consult.