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Review
. 2010 Jun 21:2:87-98.
doi: 10.2147/hmer.s6918.

Optimal management of hepatorenal syndrome in patients with cirrhosis

Paolo Angeli  1 , Filippo Morando  1
Affiliations
Review

Optimal management of hepatorenal syndrome in patients with cirrhosis

Paolo Angeli et al. Hepat Med. .

Abstract

Hepatorenal syndrome (HRS) is a functional renal failure that often occurs in patients with cirrhosis and ascites. HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. There are 2 different types of HRS. Type 1 HRS, which is often precipitated by a bacterial infection, especially spontaneous bacterial peritonitis, is characterized by a rapidly progressive impairment of renal function. Despite its functional origin, the prognosis of type 1 HRS is very poor. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure but refractory ascites and its impact on prognosis is less negative. New treatments (vasoconstrictors plus albumin, transjugular portosystemic shunt, and molecular adsorbent recirculating system), which were introduced in the past 10 years, are effective in improving renal function in patients with HRS. Among these treatments vasoconstrictors plus albumin can also improve survival in patients with type 1 HRS. Thus, this therapeutic approach has changed the management of this severe complication in patients with advanced cirrhosis.

Keywords: acute renal injury; albumin; ascites; bacterial infections; chronic kidney disease; cirrhosis; midodrine; renal failure; renal replacement therapy; spontaneous bacterial peritonitis; terlipressin; transjugular portosystemic shunt; vasoconstrictors.

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Figures

Figure 1
Figure 1
New diagnostic criteria of hepatorenal syndrome.
Figure 2
Figure 2
Clinical types of hepatorenal syndrome.
Figure 3
Figure 3
Pathophysiology of progressive impairment of the effective circulating volume in patients with advanced cirrhosis. Abbreviations: PRA, plasma renin activity, NA, plasma level of noradrenaline, ADH, plasma level of antidiuretic hormone.
Figure 4
Figure 4
Key points in the management of type 1 hepatorenal syndrome.
Figure 5
Figure 5
Key points in the management of type 2 hepatorenal syndrome.
See this image and copyright information in PMC

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