Current management of hepatorenal syndrome.

Abstract

Hepatorenal syndrome (HRS) is characterized by severe renal arterial vasoconstriction without other underlying pathology. As for the worsening renal function, and it can be reversible after undergoing standard treatment. HRS develops in patients with decompensated cirrhosis who have marked circulatory dysfunction due to splanchnic arterial vasodilatation resulting in deterioration of the cardiac function as well as the renal function. HRS can present in patients with acute liver failure. There are 2 types of clinical presentations of HRS: Type-1 HRS is characterized by acute renal failure and rapid deterioration of renal function as well as the other major organs dysfunction. Bacterial infection is the common precipitating cause of HRS. Type-2 HRS is characterized by slowly progressive renal failure and usually presents in cirrhotic patients with refractory ascites. Prognosis for both types of HRS is notably poor and liver transplantation is the only definitive treatment that assures long-term survival. However, various therapies that restore renal function can provide a bridge to liver transplantation, for example albumin plus vasoconstrictors, transjugular intrahepatic portosystemic shunt (TIPS) and extracorporeal albumin dialysis. Each treatment regimen has different level of evidences to support. This review provides an updated overview of the mechanisms, the diagnosis and current management of HRS.