[Renal insufficiency in patients with hepatic insufficiency]

Area of Science:

• Nephrology
• Hepatology
• Gastroenterology

Context:

• Renal dysfunction affects 20% of hospitalized cirrhosis patients, increasing mortality.
• Prerenal disorders cause two-thirds of renal dysfunction; intrarenal diseases cause one-third.
• Hepatorenal syndrome (HRS) is a type of prerenal failure unresponsive to volume therapy.

Purpose:

• To summarize the pathophysiology and treatment of hepatorenal syndrome (HRS).
• To highlight the role of terlipressin and albumin in managing HRS.
• To emphasize the importance of liver transplantation for long-term survival.

Summary:

• HRS pathophysiology involves splanchnic vasodilation, increased cardiac output, and activation of the sympathetic nervous system, RAAS, and vasopressin.
• Renal vasoconstriction in HRS is exacerbated by hepatorenal reflexes due to increased intrahepatic pressure.
• Terlipressin combined with albumin shows potential in reversing HRS in up to 50% of patients.

Impact:

• Improving kidney function before liver transplantation enhances post-transplant outcomes.
• Effective management of HRS is crucial for improving survival rates in cirrhosis patients.
• Further research into HRS treatment could lead to improved patient outcomes and reduced mortality.