Overview and management of hepatorenal syndrome

Hepatorenal syndrome (HRS) is an acute kidney injury (AKI) syndrome commonly encountered in critically ill patients with a history of cirrhosis with ascites. Given the complexity of diagnosing and managing this condition, this review aims to highlight the key features of disease pathophysiology along with prevention and treatment modalities to improve patient outcomes.

Recent meetings between the acute disease quality initiative and the internal club of ascites have renamed HRS from HRS-1 and HRS-2 to HRS-AKI and HRS-chronic kidney disease. Further changes in diagnostic strategy, largely around the implication and use of albumin resuscitation, have further been addressed and clarified in recent updates from various clinical societies.

HRS represents a challenging disease entity requiring aggressive attempts at prevention, early treatment initiation, and frequent transplant candidacy discussion to improve patient outcomes. The poor prognosis associated with this condition, particularly amongst patients with poor transplant candidacy, requires physicians to maintain high vigilance when managing patients with cirrhosis with acutely reduced renal function. By providing a review of distinct diagnostic criterion, pathophysiology, prevention strategies, and treatment modalities, we aim to provide clinicians with the tools to properly understand and manage this disease state.