Hepatorenal Syndrome: Update on pathogenesis and management
Medical Journal of Viral Hepatitis
Hepatorenal syndrome (HRS) in cirrhotic patients with ascites is a functional form of kidney failure with a very poor prognosis. It is one of the numerous potential causes of acute kidney injury (AKI) in patients with decompensated cirrhosis. The pathophysiology of this syndrome is complex with several mechanisms interacting simultaneously, including liver cirrhosis with ascites, portal hypertension, arterial vasodilation, systemic inflammation and bacterial translocation. Although different
... though different medical modalities of treatment of HRS are available, the liver transplantation remains the treatment of choice. The aims of medical treatment are to stabilize the patients until liver transplantation and to optimize their pre-transplant clinical conditions. Most of these therapies have targeted the haemodynamic perturbations that are thought to underlie the pathophysiology of HRS, including systemic and splanchnic vasodilation. Other management options, such as transjugular intrahepatic portosystemic shunt, renal replacement therapy and molecular absorbent recirculating system, may provide short-term benefit for patients not responding to medical therapy whilst awaiting transplantation. This review demonstrate the diagnostic approach to HRS, the underlie pathophysiology events and the therapeutic measures currently adopted in clinical practice.