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[Hepatorenal syndrome].

Elena Mancini¹

¹U.O.C. Nefrologia Dialisi Ipertensione, Policlinico S. Orsola-Malpighi, Bologna, Italy. elena.mancini@osp.bo.it

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia

|November 3, 2012

Summary

This summary is machine-generated.

Hepatorenal syndrome (HRS) involves kidney failure in cirrhosis patients. New treatments like terlipressin and albumin offer hope for renal recovery, improving outcomes.

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Area of Science:

Nephrology
Hepatology
Gastroenterology

Context:

Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis.
It is characterized by progressive splanchnic and systemic circulatory changes leading to renal dysfunction.
Triggering events precipitate a multiorgan dysfunction syndrome, including reduced urinary output.

Purpose:

To outline the pathophysiology and clinical manifestations of Hepatorenal Syndrome (HRS).
To discuss the progression rates differentiating HRS type 1 and type 2.
To review current and emerging treatment strategies for HRS.

Summary:

HRS involves complex interactions of the sympathetic nervous system, renin-angiotensin system, and vasoactive hormones.
Clinical features include sodium/water retention, ascites, edema, hyponatremia, and intrarenal vasoconstriction causing glomerular filtration inhibition.
While liver transplantation historically resolved HRS, pharmacological therapies like terlipressin with albumin show promise for renal recovery in 40-60% of patients.

Impact:

Pharmacological therapy with vasoconstrictors (e.g., terlipressin) and albumin offers a new treatment avenue for HRS.
Extracorporeal depuration systems may improve short-term survival in patients awaiting transplantation.
Prevention strategies, including prophylactic antibiotics and albumin, are crucial for managing advanced cirrhosis and preventing HRS.