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[The hepatorenal syndrome]

S Møller¹, J Abrahamsen, H Ring-Larsen

¹Hvidovre Hospital, klinisk fysiologisk/nuklearmedicinsk afdeling 239, København.

Ugeskrift for Laeger

|May 29, 1995

Summary

Hepatorenal syndrome (HRS) is kidney failure in liver disease, marked by low GFR and sodium retention. Liver transplantation offers the ultimate treatment for this condition.

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Area of Science:

Nephrology
Hepatology
Gastroenterology

Background:

Renal dysfunction and abnormal sodium-water handling are common in liver disease.
Hepatorenal syndrome (HRS) is a functional renal failure with decreased glomerular filtration rate (GFR), sodium retention, and oliguria.
Reduced renal blood flow (RBF), particularly in the renal cortex, is a key pathogenic feature of HRS.

Purpose of the Study:

To define hepatorenal syndrome (HRS) and its characteristics.
To explore the contributing factors in the pathogenesis of HRS.
To discuss the prognosis and treatment options for HRS.

Main Methods:

Literature review and synthesis of existing knowledge on HRS.
Analysis of pathogenic factors including liver function, hemodynamics, and neuro-humoral regulation.
Evaluation of therapeutic interventions and their efficacy.

Main Results:

HRS is characterized by decreased GFR, sodium retention, and oliguria due to reduced RBF.
Pathogenesis involves decreased liver function, deranged hemodynamics (blood pressure, volume, flow distribution), and altered neuro-humoral regulation.
Therapies like peritoneovenous shunt and plasma expansion show limited success, primarily in early stages.

Conclusions:

The prognosis for HRS is poor, with disappointing therapeutic outcomes.
Future research should focus on addressing reduced liver function and hemodynamic abnormalities, especially renal vasoconstriction.
Liver transplantation remains the definitive treatment for HRS.

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