The management of hepatorenal syndrome.
The hepatorenal syndrome (HRS) is a common complication in advanced liver cirrhosis, and often occurs in patients with ascites and severe circulatory dysfunction. HRS is a functional renal failure which was believed to be the end result of progressive splanchnic vasodilatation. However, recent data have implicated a role of reduced cardiac output as well as endothelial dysfunction in the etiology of HRS. Type 1 HRS is associated with a poor prognosis and often occurs in conjunction with microcirculatory dysfunction in other organs, including the heart, brain and liver. The treatment of type 1 HRS has centered around vasoconstrictors and intravenous hydration, traditionally midodrine and albumin. However, new vasoconstrictors (specifically vasopressin analogues), transjugular intrahepatic portacaval shunts, and albumin dialysis have been introduced as potential therapies. This review will discuss new advances in the diagnosis and pathogenesis of HRS, with an emphasis on the management.
Carl
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Department of Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, VA 23298-0160, USA. dcarl@mcvh-vcu.edu
Sanyal
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A
D000418:Albumins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D008879:Midodrine / Q000627:therapeutic use; D009638:Norepinephrine / Q000031:analogs & derivatives; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000418:Albumins; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008879:Midodrine; D009638:Norepinephrine