Hepatorenal syndrome

Hepatorenal syndrome (HRS) is liver failure that results in concomitant renal failure. Prognosis is generally very poor. more...

The renal failure in HRS is thought to result from renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) activation. Kidneys that are normal typically resume functioning following a successful liver transplantation.

It is estimated that 40% of patients with cirrhosis and ascites, which are stigmata of chronic liver disease, will develop HRS during the course of their disease.

HRS classified in to Type I HRS and Type 2 HRS

• Type I HRS is associated with spontaneous bacterial peritonitis. Median survival of Type I HRS, without treatment, is less than two weeks.
• Type II HRS is characterized by relatively stable hepatic function. Survival in Type II HRS is typically 3-6 months.

Treatment

Acute treatment involves maintaining the blood pressure. Several vasoactive agents, including terlipressin, midrodrine and norepinephrine, have shown some benefit. These agents should be given concomitantly with intravenous infusion of albumin. If the patient is taking diuretics, they should be discontinued.

The definitive treatment for HRS is liver transplantation. Transjugular intrahepatic portosystemic shunts (TIPS) and liver dialysis have shown some promise for HRS patients.

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