[Hepatorenal syndrome: pathogenesis and treatment]

Hepatorenal syndrome has been known for many years as one of the main complications of cirrhosis. The etiology was unknown for many years, although it was already accepted in the past as a functional renal failure, without renal pathology. The syndrome mostly develops in advanced cirrhosis patients, and some risk factors hasten its development. In recent years there has been considerable progress in the understanding of this syndrome, and some studies found a connection between renal failure and splanchnic vasodilatation, systemic and renal vasoconstriction, high NO level in the splanchnic system, and high neuroadrenaline and renin levels in the blood. The most accepted theory to explain the etiology of the syndrome in known as the "arterial vasodilatation theory". Lately, cardiac involvement in the syndrome was also found, with low cardiac output. The explanation for this is still unclear. The treatment for the hepatorenal syndrome was recently developed, and is based on pathophysiology. Vasoconstrictors with plasma expanders, mostly albumin, were found effective in improving the renal function in patients with hepatorenal syndrome in some studies, with improved chances to complete liver transplantation successfully. It is now well accepted as the treatment of choice until liver transplantation can be performed.