Hepatorenal syndrom (HRS) pathogenetic mechanisms, diagnosis and treatment Urszula Ołdakowska-Jedynak, Marek Krawczyk Medical Science Review - Hepatologia 2010; 10 45-51 aaICID: 911673
Article type: Review article
IC™ Value: 3.34
Abstract provided by Publisher
Hepatorenal syndrome (HRS) is characterized by functional renal vasoconstriction that results in pronounced reduction in GFR with minimal histologic abnormalities. This condition is related to marked alteration in circulatory function, mainly reduction in systemic vascular resistance due to primary arterial vasodilatation in the splanchnic vascular bed, induced by portal hypertension. Patients with HRS have sodium retention and water overload. HRS occurs in patients with cirrhosis, ascites and liver failure, in patients with acute liver failure or alcoholic hepatitis. There are two types of HRS. Type 1 of HRS is acute and rapid progressive renal failure. It develops spontaneously or due to precipitating factors: bacterial infections, gastrointestinal bleeding. Since specific diagnostic tests are laking, HRS is diagnosed by exclusion of other known etiological factor of renal failure. The prognosis is very poor and HRS is strong predictor of mortality. Recommendation for the treatment of HRS type 1 include: vasoconstrictors(terlipresin, midodrine, octreotid) plus albumin, TIPS in patients without severe liver failure in whom vasoconstrictors have failed, liver transplantation, extracorporeal albumin dialysis, renal replacement therapy if needed. Type 2 HRS is typically associated with refractory ascites and moderate renal failure with slowly progressive clinical course. Patients with HRS type 2 should be managed with following measures: dietary sodium and fluid intake restriction, diuretics, repeated paracentesis plus albumin to treat recurrent tense ascites, vasoconstrictor drugs or TIPS (data insufficient), liver transplantation. The treatment of choice for both types of HRS is liver transplantation.