Risk factors of hepatorenal syndrome

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What factors can precipitate the development of hepatorenal syndrome?

Any condition that causes a further reduction of the effective arterial blood volume can precipitate hepatorenal syndrome.

These include over-diuresis, large-volume paracentesis (≥5 liters) without intravascular colloid replacement in patients with refractory ascites, and gastrointestinal bleeding.

Other triggers are conditions that worsen the arterial vasodilatation, such as sepsis (especially SBP) or jaundice due to obstruction in the biliary tree (bile acids are vasodilators).

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