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Understanding and Treating Hepatorenal Syndrome: Insights from Recent Research
Yuli Song1, Xiaochen Yang1, Chengbo Yu1
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.
Seminars in Liver Disease
|April 1, 2025
Summary
Hepatorenal syndrome (HRS), a type of acute kidney injury (AKI), is a severe complication in advanced cirrhosis. Early diagnosis and treatment with vasoconstrictors and albumin are crucial for improving outcomes before liver transplantation.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Acute kidney injury (AKI) is a critical complication in decompensated cirrhosis, significantly impacting survival.
- Hepatorenal syndrome (HRS) is a specific AKI subtype in advanced cirrhosis, characterized by kidney dysfunction and poor prognosis.
- Pathogenesis involves splanchnic vasodilation, circulatory dysfunction, and reduced renal perfusion, exacerbated by systemic inflammation.
Purpose of the Study:
- To provide an updated understanding of hepatorenal syndrome (HRS).
- To review the pathophysiology, diagnosis, management, and future challenges of HRS.
- To synthesize recent expert consensus on HRS.
Main Methods:
- Literature review of recent studies and expert consensus.
- Analysis of pathophysiology, diagnostic challenges, and treatment strategies.
- Focus on current understanding of HRS in decompensated cirrhosis.
Main Results:
- HRS involves complex pathophysiological mechanisms leading to renal impairment.
- Diagnosis is challenging due to lack of specific biomarkers, often requiring differentiation from acute tubular necrosis.
- Risk factors include spontaneous bacterial peritonitis, infections, and large-volume paracentesis without albumin.
Conclusions:
- Current management relies on vasoconstrictors (e.g., terlipressin) and albumin.
- Liver transplantation remains the definitive treatment for HRS.
- Further research is needed to address diagnostic and therapeutic challenges.
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