The Physiology of Hepatorenal Syndrome

Hepatorenal syndrome is a deadly consequence of ascites and decompensated cirrhosis which leads to renal dysfunction. In cirrhosis, portal hypertension triggers vasodilator release, causing fluid retention and decrease in circulating volume, activating the RAS system and resulting in renal vasoconstriction. This delicate balance can be disrupted by triggers like infections or large volume paracentesis, leading to severe AKI.