[Hepatorenal syndrome]

Abstract

Liver and kidney are essential organs for maintaining metabolic balance because of their detoxificational, excretory and regulatory functions. Liver insufficiency, especially alcohol-induced hepatocirrhosis with ascites may cause functional, potentially reversible kidney failure known as hepatorenal syndrome (HRS). Hepato-renal syndrome is the reason for 8-30% cases of acute kidney failure in cirrhotic patients. It is also an independent risk factor of mortality in this group of patients. There are two types of HRS with different dynamics of clinical course and different prognosis for long term survival of patients. The only efficient treatment for HRS is transplantation of liver or it's right lobe from a living donor. Transplantation removes unbeneficial effects of liver failure and also in most cases restores proper kidney function. The other methods of treatment concentrate to improve and retain kidney function as long as possible and simultaneously to reduce mortality in patients awaiting for liver transplantation. Some of them are: administration of intravenous albumin, diuretics and arterial vasoconstrictors or correction of portal hypertension with a trans-jugular intrahepatic portacaval shunt (TIPS). In patients qualified to liver transplantation renal replacement therapy should also be undertaken. The newest supporting extracorporeal technique for liver insufficiency with/or without HRS is albumin dialysis with MARS of Prometheus devices.