[Hepatorenal syndrome]

The association of renal failure with terminal liver insufficiency is referred to as hepatorenal syndrome (HRS). It is characterized by impaired renal function together with abnormalities in arterial circulation and activity of endogenous vasoactive system. In the pathogenesis of HRS, vasodilatation in the splanchnic circulation plays a major role. This leads to underfilling in arterial circulation in this area with subsequent vasoconstriction in renal arteries leading to lower renal circulation and functional renal failure. One of the most difficult tasks in clinical evaluation of patients with cirrhosis is to diagnose renal functions, because the standard methods used in evaluation of glomerular filtration are not reliable. The most important agents in the treatment of patients with cirrhosis, ascites and HRS are identification, prevention of precipitating factors, correction and treatment of prerenal failure and acute tubular necrosis. Up to now, the only effective treatment of HRS is ortothopic liver transplantation, which cannot be applied in all patients.

HRS is a serious complication of liver diseases with a very bad prognosis qouad vitam and qouad sanationem, which is only rarely reversible. After diagnosing HRS, the renal insufficiency is already mostly progressive, and patients have only a minimal chance to improve their renal functions. The only currently proved treatment modality, which is successful in terms of improving renal functions and long-term survival rate is liver transplantation. (Tab. 2, Fig. 1, Ref. 28.)