Renal failure in liver disease may reflect Rare disorders that directly affect both the kidneys and the liver (eg, carbon tetrachloride toxicity) Circulatory failure with decreased renal perfusion, with or without frank acute tubular necrosis Functional renal failure, often called hepatorenal syndrome Hepatorenal syndrome This syndrome consists of Progressive oliguria and azotemia in the absence of structural damage to the kidneys Hepatorenal syndrome usually occurs in patients with alcoholic hepatitis or advanced cirrhosis with ascites.