Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis☆
Hepatorenal syndrome is a severe complication of advanced liver cirrhosis, in patients with ascites and marked circulatory dysfunction. It is clearly established that it has a functional nature, and that it is related to intense renal vasoconstriction. Despite its functional origin, the prognosis is very poor. In the present review, the most recent advances in diagnosis, pathophysiology, and treatment are discussed. Recent developments in pathophysiology are the basis of the new therapeutic strategies, which are currently under evaluation in randomised clinical trials.
Abbreviations: HRS, hepatorenal syndrome, ATN, acute tubular necrosis, NO, nitric oxide, TIPS, transjugular intravenous porto-systemic shunt, OLT, orthotopic liver transplantation, MARS, molecular adsorbent recirculating system, SBP, spontaneous bacterial peritonitis
Keywords: Renal failure, Vasoconstrictors, Human albumin, Terlipressin
☆ The authors declare that they do not have anything to disclose regarding industry funding or conflict of interest with respect to this manuscript. The authors declare that they received funding from the University of Padova and the Italian Ministry for University and Research.
PII: S0168-8278(08)00056-1
doi:10.1016/j.jhep.2008.01.010
© 2008 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
