Topic Highlight
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 28, 2012; 18(36): 4978-4984
Published online Sep 28, 2012. doi: 10.3748/wjg.v18.i36.4978
Hepatorenal syndrome
Jan Lata
Jan Lata, Department of Internal Medicine, University Hospital and Faculty of Medicine, Ostrava University, 70103 Ostrava, Czech Republic
Author contributions: Lata J contributed solely to this work.
Correspondence to: Jan Lata, Professor, MD, PhD, Department of Internal Medicine, University Hospital and Faculty of Medicine, Ostrava University, Dvorakova 7, 70103 Ostrava, Czech Republic.
Telephone: +420-59-7091013 Fax: +420-59-6118219
Received: December 12, 2011
Revised: June 4, 2012
Accepted: June 15, 2012
Published online: September 28, 2012

Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension. This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys, where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration, which ultimately results in uraemia. The syndrome occurs almost exclusively in patients with ascites. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation is the most appropriate therapeutic method, nevertheless, only a few patients can receive it. The most suitable “bridge treatments” or treatment for patients ineligible for a liver transplant include terlipressin plus albumin. Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response. Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term. Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.

Keywords: Liver cirrhosis, Hepatorenal syndrome, Ascites, Vasoconstrictors, Terlipressin