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Recent advances in hepatorenal syndrome
Vicente Arroyo1, Aldo Torre, Mónica Guevara
1Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona School of Medicine, Barcelona, Catalunya, Spain. arroyo@medicina.ub.es
Tropical Gastroenterology : Official Journal of the Digestive Diseases Foundation
|June 25, 2005
Summary
Hepatorenal syndrome (HRS) is severe kidney failure in advanced cirrhosis, often fatal. While new treatments improve kidney function, liver transplantation remains the best option for suitable patients.
Area of Science:
- Gastroenterology and Hepatology
- Nephrology
- Critical Care Medicine
Background:
- Hepatorenal syndrome (HRS) is a frequent complication of advanced cirrhosis.
- It involves kidney failure and circulatory dysfunction due to renal vasoconstriction.
- HRS is linked to arterial underfilling from splanchnic vasodilatation.
Purpose of the Study:
- To review the pathophysiology, diagnosis, prognosis, and treatment of Hepatorenal Syndrome.
- To highlight the role of liver transplantation and emerging therapies.
Main Methods:
- Diagnosis relies on excluding other causes of renal failure.
- Prognosis is poor, especially for Type 1 HRS.
- Current therapies include vasoconstrictors and transjugular intrahepatic portosystemic shunt (TIPS).
Main Results:
- Vasoconstrictor drugs and TIPS can improve renal function.
- Liver transplantation is the most effective treatment for HRS.
- Despite improvements, HRS prognosis remains poor without transplantation.
Conclusions:
- Hepatorenal syndrome necessitates prompt diagnosis and management.
- While new therapies offer temporary improvement, liver transplantation is crucial for long-term survival.
- Even after renal function improvement, liver transplantation should be considered for suitable HRS patients.