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[Hepatorenal syndrome : something new?]
Hannah Wozniak1, Patrick Saudan2, Pierre-Yves Martin2
1Service de médecine interne générale, HUG, 1211 Genève 14.
Abstract:
Hepatorenal syndrome is a serious and frequent complication in patients suffering from liver cirrhosis. Its most severe type is characterized by the rapid occurrence of a functional acute kidney injury. However it is mainly an exclusion diagnosis. Although the pathophysiology is not yet fully understood, the principal hypothesis is a splanchnic vasodilatation leading to a systemic and renal vasoconstriction associated with sodium and water retention and progressive cardiac failure. Intravenous albumin associated with systemic vasoconstrictors, terlipressin or noradrenaline, is recommended. Because this pathology is associated with high mortality rate, liver transplantation should be discussed. A multidisciplinary approach is mandatory due to the renal disease but also to multiorganic failure.
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