Program Operations Manual System (POMS)
TN 32 (08-20)
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COMPASSIONATE ALLOWANCES INFORMATION
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HEPATORENAL SYNDROME
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ALTERNATE NAMES
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Hepatorenal Syndrome Type I/II; Hepato Renal Syndrome
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DESCRIPTION
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Hepatorenal Syndrome (HRS)
is a condition in which there is progressive kidney failure in a person with cirrhosis
of the liver, along with portal hypertension and ascites. It is a serious and often
life-threatening complication of cirrhosis. HRS occurs when there is a decrease in
kidney function in a person with a severe liver disorder. It occurs when there is
a decrease in the amount of urine that is removed from the body due to severe liver
dysfunction resulting in an increase of nitrogen-containing waste products in the
bloodstream (azotemia).
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: HRS is diagnosed when other causes of kidney failure are clinically ruled out.
Laboratory studies may include:
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BUN and serum creatinine levels;
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Urinalysis showing increased urine specific gravity; and
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Tests for low serum sodium and very low urine sodium concentration.
Liver tests will show increased prothrombin time, low serum albumin, and sometimes
increased serum ammonia levels.
Imaging studies may include abdominal ultrasound. Signs of hepatic encephalopathy
may also be present.
Physical findings: Symptoms of HRS may include:
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Orthostatic hypotension (a fall in blood pressure occurring when a person sits up
or stands up suddenly);
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Decreased urine production (oliguria);
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Unexplained weight gain; and
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The clinical examination will also show signs of chronic liver failure.
ICD-9: 572.4
ICD-10:
K76.7
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PROGRESSION
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A diagnosis of HRS occurs in up to 1 in 10 people who are in the hospital due to liver
failure and is diagnosed when other causes of kidney failure are ruled out. Complications
of HRS may include bleeding, damage to and failure of multi-organ systems, end stage
kidney disease, fluid overload with congestive heart failure or pulmonary edema, hepatic
coma and secondary infections. The prognosis for people with HRS is poor. Mortality
is usually associated with secondary infection or severe bleeding (hemorrhage).
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TREATMENT
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Liver transplantation is the only definitive treatment for HRS. Alternative treatments
are supportive and symptomatic. Dialysis, nonsurgical shunt (TIPS) and surgical shunts
(Levine) relieve the symptoms of kidney failure.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and physical examination that describes the diagnostic features of
the impairment;
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Medical records showing functional renal failure in the absence of underlying kidney
pathology; and
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Laboratory studies documenting serum creatinine elevation of at least 2 mg/dL; or
oliguria with 24-hour urine output < 500 mL; or sodium retention with urine sodium
< 10 mEq per liter.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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5.05 D
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The criteria in listing 5.05 D are met with documentation of chronic liver disease
and any one of the three laboratory findings on one evaluation.
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105.05 D
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Equals
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| * Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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