Recent advances in pathophysiology, diagnosis and management of hepatorenal syndrome: A review

Abstract

Hepatorenal syndrome with acute kidney injury (HRS-AKI) is a form of rapidly progressive kidney dysfunction in patients with decompensated cirrhosis and/or acute severe liver injury such as acute liver failure. Current data suggest that HRS-AKI occurs secondary to circulatory dysfunction characterized by marked splanchnic vasodilation, leading to reduction of effective arterial blood volume and glomerular filtration rate. Thus, volume expansion and splanchnic vasoconstriction constitute the mainstay of medical therapy. However, a significant proportion of patients do not respond to medical management. These patients often require renal replacement therapy and may be eligible for liver or combined liver-kidney transplantation. Although there have been advances in the management of patients with HRS-AKI including novel biomarkers and medications, better-calibrated studies, more widely available biomarkers, and improved prognostic models are sorely needed to further improve diagnosis and treatment of HRS-AKI.

Keywords: Hepatorenal syndrome; Pathophysiology; Diagnosis; Management; Review

Core Tip: Hepatorenal syndrome (HRS) is a specific form of acute kidney injury that occurs in the presence of severe acute liver injury (e.g., acute liver failure or severe alcoholic hepatitis), decompensated cirrhosis, or acute on chronic liver failure and is particularly associated with poor prognosis. Here, we reviewed some of the recent advancements in the diagnosis and treatment of HRS.