Core IM | Internal Medicine Podcast #190: Hepatorenal Syndrome Part 1: 5 Pearls Segment
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Oct 15, 2025 Dr. Juan Carlos-Velez, a nephrologist from Ochsner Health, dives into the intricacies of hepatorenal syndrome (HRS). He explains how portal hypertension triggers pathophysiological changes in the kidneys and distinguishes HRS from other acute kidney injury causes. The discussion covers the diagnostic challenges posed by serum and urine sodium levels. Dr. Velez also highlights when albumin should be used strategically and how evolving criteria for HRS diagnosis are reshaping clinical practices.
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HRS Is Portal Hypertension Physiology
- Hepatorenal syndrome (HRS) is driven by portal hypertension causing systemic vasodilation and kidney vasoconstriction via SNS and RAAS.
- The kidney is structurally normal but underperfused and can recover if vasoconstriction is reversed.
Check For Portal Hypertension First
- Evaluate vitals and look for signs of worsening portal hypertension before labeling AKI as HRS.
- If no ascites or portal-hypertension signs are present, do not diagnose HRS.
UA Differentiates HRS From Glomerular Disease
- A bland urinalysis suggests HRS, while proteinuria, hematuria, or leukocyturia point to glomerular disease.
- Consider hepatitis-associated GN or IgA nephropathy in cirrhosis with abnormal UA.