[The hepatorenal syndrome]

Abstract

Renal dysfunction and abnormal sodium-water handling are frequent in liver disease. The term hepatorenal syndrome (HRS) denotes a functional type of renal failure characterized by a progressive decrease in the glomerular filtration rate (GFR), greatly increased sodium retention, a high urine/plasma ratio of solutes, azotaemia, and oliguria. The main pathogenic feature is reduced renal blood flow (RBF), especially in the cortex. The kidney is morphologically intact and has been shown to rapidly regain normal function after transplantation to a recipient with a healthy liver. Three factors should be considered in the pathogenesis of HRS: 1) decreased liver function; 2) deranged haemodynamics, including abnormal blood pressure, blood volume, and blood flow distribution; and 3) deranged neuro-humoral regulation. The prognosis in HRS is very poor, and therapy for HRS has proved disappointing. However future studies should be directed towards the reduced liver function and the haemodynamic abnormalities, especially the abnormal renal vasoconstriction. Implantation of a peritoneovenous shunt, paracentesis with plasma expansion, certain "blockers", and normalization of arterial blood pressure have reversed the HRS only in the more early stages. Liver transplantation is the ultimate treatment for the HRS.