Pathophysiology of the hepatorenal syndrome and potential for therapy

Acute renal failure is frequently observed in patients with ascites and alcoholic cirrhosis of the liver. In the absence of any discernible anatomic or clinical cause for the renal failure, the decrease in renal perfusion is usually associated with significant arterial hypovolemia. If there is no contraction of the effective blood volume, then the functional renal failure is entitled to be labeled "hepatorenal syndrome." This implies that there is some unique cause for intrarenal vasoconstriction independent of a contracted effective arterial blood volume. A possible cause for such vasoconstriction may be abnormal intrarenal production of prostaglandins. Therapy is ineffective, but calcium antagonists may have some therapeutic potential.