Pathogenesis of Hepatorenal Syndrome: Implications for Therapy.
Patients with cirrhosis are prone to develop acute kidney injury (AKI) due to a number of causes, including bacterial infections with or without septic shock, hypovolemia, administration of nephrotoxic drugs, and intrinsic kidney diseases, among others. Most importantly, patients with advanced cirrhosis develop a distinctive cause of AKI, characterized by rapidly progressive glomerular filtration rate loss associated with marked disturbances in circulatory function in the absence of obvious pathologic abnormalities in the kidneys, known as hepatorenal syndrome (HRS). Decreased kidney function results from intense renal vasoconstriction secondary to the complex circulatory changes of cirrhosis with splanchnic vasodilatation and effective hypovolemia. Beyond activation of vasoactive systems, factors including impaired renal blood flow autoregulation and systemic inflammation may play a role in the development of HRS. Most patients improve with albumin and vasopressors; however, the prognosis of HRS remains very poor. Novel biomarkers may be helpful in distinguishing HRS from other causes of AKI in patients with cirrhosis.
Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, University Paris VII Diderot, INSERM U1149, Paris, France.
François
F
Durand
Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Institut d'Investigación Biomediques, Barcelona, Centro de Investigaciones Biomédicas en Red en Enfermedades Digestivas y Hepáticas (CIBEREHD), Spain.
Isabel
I
Graupera
Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Institut d'Investigación Biomediques, Barcelona, Centro de Investigaciones Biomédicas en Red en Enfermedades Digestivas y Hepáticas (CIBEREHD), Spain.
Pere
P
Ginès
Hepatology and Transplant Critical Care, University of Kansas Medical Center, Kansas City, KS.
Jody C
JC
Olson
Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: nadim@usc.edu.
Mitra K
MK
Nadim
D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005919:Glomerular Filtration Rate / Q000502:physiology; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D020896:Hypovolemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged
Hepatorenal syndrome (HRS); acute kidney injury (AKI); biomarkers; cirrhosis; liver transplantation; pathophysiology; renal function; review; simultaneous liver-kidney transplantation; vasoconstrictor drugs