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Hepatorenal syndrome: Current concepts and future perspectives
Chan-Young Jung1, Jai Won Chang1
1Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clinical and Molecular Hepatology
|April 13, 2023
Summary
Hepatorenal syndrome (HRS), now called HRS-acute kidney injury (AKI), is a severe kidney complication in advanced cirrhosis. Management involves liver transplantation, vasoconstrictors, albumin, and sometimes kidney replacement therapy.
Area of Science:
- Nephrology
- Hepatology
- Gastroenterology
Background:
- Hepatorenal syndrome (HRS) is a critical complication in advanced cirrhosis, frequently preceding liver transplantation (LT) and leading to mortality.
- Recent advancements have revised the understanding, diagnosis, and classification of HRS, particularly HRS type 1, now termed HRS-acute kidney injury (AKI).
- Pathophysiology involves splanchnic vasodilation, renal vasoconstriction, nitric oxide dysfunction, and systemic inflammation, complicating kidney function in cirrhosis.
Purpose of the Study:
- To provide an updated overview of hepatorenal syndrome (HRS), focusing on its revised nomenclature and diagnostic criteria.
- To discuss the diagnostic challenges, current treatment strategies, and emerging therapies for HRS-AKI.
- To highlight the critical role of liver transplantation as the definitive treatment for HRS-AKI.
Main Methods:
- Review of current literature on hepatorenal syndrome pathophysiology, diagnosis, and management.
- Analysis of revised diagnostic criteria for HRS-AKI.
- Evaluation of treatment modalities including pharmacological interventions, albumin infusion, kidney replacement therapy, and liver transplantation.
Main Results:
- HRS-AKI is characterized by functional kidney impairment without histological abnormalities, posing diagnostic challenges compared to other forms of AKI.
- Treatment involves vasoconstrictors and albumin to improve renal perfusion, with kidney replacement therapy (KRT) as a bridge to transplantation for refractory cases.
- Liver transplantation remains the optimal treatment, while other interventions like TIPS and artificial liver support show limited efficacy.
Conclusions:
- Accurate diagnosis of HRS-AKI is crucial, relying heavily on differential diagnosis due to the absence of specific biomarkers.
- Pharmacological management and KRT can stabilize patients awaiting liver transplantation, which offers the best prognosis.
- Further research is needed to validate novel therapies aimed at improving outcomes for patients with HRS-AKI.
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