title: [Hepatorenal syndrome: focus].
abstract: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis. It develops as a result of abnormal hemodynamics, leading to systemic vasodilatation and renal vasoconstriction. Increased bacterial translocation, various cytokines and systemic inflammatory response system contribute to splanchnic vasodilatation, and altered renal autoregulation. An inadequate cardiac output with systolic incompetence increases the risk of renal failure. Type 1 HRS is usually initiated by a precipitating event associated with an exaggerated systemic inflammatory response, resulting in multiorgan failure. Vasoconstrictors are the basic treatment in patients with type 1 HRS; terlipressin is the superior agent. Norepinephrine can be used as an alternative. Transjugular intrahepatic portosystemic stent shunt may be applicable in a small number of patients with type 1 HRS and in most patients with type 2 HRS. Liver transplantation is the definitive treatment for HRS. The decision to do simultaneous or sequential liver and kidney transplant remains controversial. In general, patients who need more than 8 to 12 weeks of pretransplant dialysis should be considered for combined liver-kidney transplantation.
authors.affiliation: Service de néphrologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Gueutin
authors.forename: Aimele
authors.initials: A
authors.lastname: Meftah
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Desbuissons
authors.forename: Lamis
authors.initials: L
authors.lastname: Debchi
authors.forename: Anne-Lyse
authors.initials: AL
authors.lastname: Langlois
authors.forename: Nathalie
authors.initials: N
authors.lastname: Shehwaro
authors.forename: Hassane
authors.initials: H
authors.lastname: Izzedine
mesh_terms: D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans
keywords: Acute kidney injury; Cirrhose hépatique; Greffe hépatique; Hypertension portale; Insuffisance rénale aiguë; Liver cirrhosis; Liver transplantation; Portal hypertension; Vasoconstricteurs; Vasoconstrictors