title: [Hepatorenal syndrome].
abstract: Hepatorenal syndrome is a severe complication of end-stage liver disease. The pathophysiological hallmark is severe renal vasoconstriction, resulting from peripheral and splanchnic vasodilation as well as activation of renal vasoconstrictor molecules, which induce the effective arterial volume reduction and the functional renal failure. The diagnosis of hepatorenal syndrome is currently based on the exclusion of other causes of renal failure (especially prerenal). Spontaneous bacterial peritonitis is one of the triggering factors and should be sought in all patients with severe liver disease and acute renal failure. Quickly treating patients with parental antibiotics and albumin infusion significantly decreases the risk. The combined use of intravenous albumin, splanchnic and peripheral vasoconstrictor and/or renal replacement therapy sometimes enables a delay until liver transplantation (or combined liver-kidney in selected patients). Transplantation is in fact the only way to improve the long-term prognosis.
authors.affiliation: Service de néphrologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France. Electronic address: evangeline.pillebout@sls.aphp.fr.
authors.forename: Evangéline
authors.initials: E
authors.lastname: Pillebout
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis; D000418:Albumins / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D015994:Incidence; D007511:Ischemia / Q000209:etiology; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000150:complications; D017093:Liver Failure / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012079:Renal Circulation; D006435:Renal Dialysis; D014661:Vasoconstriction
chemical_list: D000418:Albumins; D000900:Anti-Bacterial Agents
keywords: Acute renal failure; End-stage liver disease; Hepatorenal syndrome; Insuffisance rénale aiguë; Maladie du foie en phase terminale; Splanchnic vasodilatation; Syndrome hépatorénal; Vasodilatation splanchnique