[Hepatorenal syndrome. What's new in 2007?].
BACKGROUND
Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease that was associated with a fatal prognosis in the past. A clear definition of HRS and increased understanding of the pathogenesis have led to considerable progress in therapy outcome.


METHODS
The major pathogenetic factor is vasodilation of the mesenteric circulation with arterial underfilling and consecutive renal vasoconstriction.
Restoration of an effective arterial blood volume can be achieved by the combination of vasopressor therapy (terlipressin, norepinephrine), in combination with volume expansion (albumin) with a success rate of up to 75%. Restoration of the effective arterial blood volume may also be achieved by implantation of a transjugular intrahepatic portosystemic stent (TIPS). This has also been successful in up to 50% of patients in selected cohorts. Finally, extracorporeal liver support systems based on exchange or detoxification of albumin have been successfully employed in a number of patients. Liver transplantation remains the only principal therapy of HRS as this is the single measure with a curative intent. All other forms of therapy are palliative but may serve as a bridge to liver transplantation.
Witzke
Oliver
O
Klinik für Nieren- und Hochdruckkrankheiten, Medizinische Klinik, Universitätsklinikum Essen, Essen, Deutschland. oliver.witzke@uk-essen.de
Gerken
Guido
G
Kribben
Andreas
A
Philipp
Thomas
T
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D005440:Fluid Therapy; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000098:blood supply; D017093:Liver Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D016031:Liver Transplantation; D008638:Mesenteric Arteries / Q000503:physiopathology; D011379:Prognosis; D006435:Renal Dialysis; D012709:Serum Albumin / Q000008:administration & dosage; D015996:Survival Rate; D014661:Vasoconstriction / Q000502:physiology; D014664:Vasodilation / Q000502:physiology; D014667:Vasopressins / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D012709:Serum Albumin; D014667:Vasopressins