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Hepatorenal syndrome.

Bimaljit Singh Sandhu1, Arun J Sanyal

  • 1Division of Gastroenterology, Hepatology & Nutrition, VCU Medical Center, MCV Box 980341, Richmond, VA 23298, USA.

Current Treatment Options in Gastroenterology
|November 30, 2005
PubMed
Summary

Hepatorenal syndrome (HRS), a kidney failure in advanced liver disease, can be treated with vasoconstrictors and albumin as a bridge to liver transplantation. Prevention strategies include albumin for spontaneous bacterial peritonitis and pentoxifylline for alcoholic hepatitis.

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Area of Science:

  • Hepatology
  • Nephrology
  • Gastroenterology

Background:

  • Hepatorenal syndrome (HRS) is characterized by functional renal failure in patients with advanced liver disease.
  • HRS presents a high mortality rate if left untreated.
  • Liver transplantation is the definitive treatment, but not all patients are candidates or receive organs promptly.

Purpose of the Study:

  • To review current and emerging treatments for hepatorenal syndrome (HRS).
  • To discuss the efficacy of vasoconstrictors, albumin, transjugular intrahepatic portasystemic shunt (TIPS), and molecular adsorbent recirculating system (MARS) in managing HRS.
  • To highlight preventive measures for HRS development.

Main Methods:

  • Review of existing literature on hepatorenal syndrome treatments.
  • Analysis of the efficacy and limitations of pharmacological interventions like terlipressin, octreotide, and midodrine.
  • Evaluation of procedural interventions such as TIPS and supportive therapies like MARS.

Main Results:

  • Terlipressin, combined with albumin, shows significant reversal rates (57-78%) for HRS, with uncommon short-term recurrence.
  • In the US, octreotide and midodrine are used, but with limited supporting data.
  • TIPS placement after response to octreotide/midodrine can sustain renal function improvement; its role requires further study due to complication risks.

Conclusions:

  • Vasoconstrictors and albumin serve as crucial bridges to liver transplantation for HRS patients.
  • TIPS and MARS show promise but require further investigation for optimal use in HRS management.
  • Preventive strategies involving albumin and pentoxifylline can reduce HRS incidence in specific patient groups.

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