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Hepatorenal Syndrome: Updates on Definition, Classification, Pathophysiology and Treatment Options.
Katherine Marchak1, Davinder Singh2, Maria Puello Barron3
1Division of Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
Techniques in Vascular and Interventional Radiology
|November 16, 2025
Summary
Hepatorenal syndrome (HRS), a severe kidney complication of liver disease, requires early diagnosis and treatment. Recent updates refine HRS classification and understanding of its complex causes, guiding interventional radiology approaches.
Area of Science:
- Hepatology
- Nephrology
- Interventional Radiology
Background:
- Hepatorenal syndrome (HRS) is a critical complication in advanced liver disease, marked by kidney dysfunction without intrinsic kidney pathology.
- It carries a high mortality rate, underscoring the need for timely identification and intervention.
- Recent International Club of Ascites (ICA) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines have updated HRS classification for better prognostic accuracy.
Purpose of the Study:
- To provide an updated review of hepatorenal syndrome (HRS) pathophysiology, diagnosis, classification, and treatment.
- To highlight the relevance of these updates for interventional radiologists.
- To discuss the role and evidence for transjugular intrahepatic portosystemic shunt (TIPS) in managing HRS.
Main Methods:
- Review of current literature on HRS pathophysiology, diagnosis, and treatment modalities.
- Analysis of updated ICA-KDIGO classification criteria for HRS.
- Examination of evidence regarding the efficacy and indications for TIPS in HRS patients.
Main Results:
- HRS pathophysiology involves complex hemodynamic disturbances, systemic inflammation, oxidative stress, and biliary injury.
- Updated classifications provide more granular subcategories reflecting disease severity and prognosis.
- Transjugular intrahepatic portosystemic shunt (TIPS) shows potential efficacy in specific HRS subpopulations, though further research is needed.
Conclusions:
- Early recognition and prompt management are crucial for improving outcomes in hepatorenal syndrome.
- Interventional radiologists play a key role in managing HRS, particularly with the consideration of TIPS.
- Further investigation is required to optimize the use of TIPS in specific HRS patient groups.
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